Published online Mar 28, 2020. doi: 10.3748/wjg.v26.i12.1340
Peer-review started: November 9, 2010
First decision: December 23, 2019
Revised: February 27, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: March 28, 2020
LNs along recurrent laryngeal nerves (RLNs) are highly involved in esophageal carcinoma. Due to limited working space in the superior mediastinum, lymphadenectomy along RLNs is very difficult and increases the risk of complications, especially RLN paralysis. Compared with lymphadenectomy along the right RLN, lymphadenectomy along the left RLN is much more difficult because of the deeper location and longer path.
In this study, we present a novel protocol, a “bilateral pedicled nerve flap” method, for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. To our knowledge, this is the first report of applying this technique for the treatment of esophageal tumors.
To search for a novel safe and effective method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy for esophageal carcinoma.
From August 2016 to February 2018, a single-institution nonrandomized study was performed in our hospital. According to the date of operation and different methods of lymphadenectomy along the left RLN, a total of 116 consecutive patients were collected and alternately allocated into two groups: 58 cases underwent the conventional method, while the other 58 cases underwent the novel method. They were all served by a single medical team and treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Postoperative complications, operative time, postoperative hospitalization, and the number of dissected LNs were compared between the two groups.
No significant difference was found between the two groups in terms of age, gender, postoperative pneumonia, anastomotic fistula, and postoperative hospitalization. The number of dissected LNs along the left RLN in the novel method was significantly higher than that of the conventional method (4.17 ± 0.359 vs 2.93 ± 0.463, P = 0.0447). Moreover, the operative time and the rate of postoperative hoarseness in the novel method were significantly lower than those of the conventional method (306.0 ± 6.774 vs 335.2 ± 7.750, P = 0.0054; 4/58 vs 12/58, P = 0.0312).
The novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position is much safer and more effective. The theories of this technique lie in better exposure of the operative field and protection of neurotrophic vessels. In the novel method, the bilateral exposure method and hollow-out method were successively performed. These not only increased the operative field of the tracheoesophageal groove, but also made the left RLN and microvessels easier to identify. Therefore, the number of dissected LNs was significantly higher in the novel group. Moreover, the operative time and the rate of postoperative hoarseness in the novel method were significantly lower than the conventional group. These findings will not only improve short-term prognosis, but also have a positive impact on long-term prognosis.