Lymphadenectomy Along the Left Recurrent Laryngeal Nerve by a Minimally Invasive Esophagectomy in the Prone Position for Thoracic Esophageal Cancer

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2010 May 25

PMID 20495981

Citations 67

Authors

Hirokazu Noshiro

Hironori Iwasaki

Kiitiro Kobayashi

Akihiko Uchiyama

Yoshihiro Miyasaka

Toshihiro Masatsugu

Kenta Koike

Kouji Miyazaki

Affiliations

Soon will be listed here.

Abstract

Background: A thoracoabdominal esophagectomy for esophageal cancer is a severely invasive procedure. A thoracoscopic esophagectomy may minimize injury to the chest wall and reduce surgical invasiveness. Conventional thoracoscopic procedures are performed in the left lateral-decubitus position. Recently, procedures performed in the prone position have received more attention because of improvements in operative exposure or surgeon ergonomics. However, the efficacy of the prone position in an aggressive thoracoscopic esophagectomy with an extensive lymphadenectomy has not been fully documented.

Methods: We successfully performed a thoracoscopic esophagectomy with a three-field extensive lymphadenectomy in 43 esophageal carcinoma patients in the prone position from December 2007 to December 2009. We describe our procedures with the patients in the prone position, focusing especially on a lymphadenectomy along the left recurrent laryngeal nerve where the nodes are frequently involved and precise dissection is technically challenging. To determine further the advantages of this position, we retrospectively compared surgical outcomes in 43 patients to those of 34 patients who underwent a thoracoscopic esophagectomy in the left lateral decubitus position as a historical control from January 2006 to November 2007.

Results: It was easier to explore the operative field around the left recurrent laryngeal nerve during a thoracoscopic esophagectomy in the prone position. The mean duration of the aggressive thoracoscopic procedure in the prone position was 307 min, which was significantly longer than in the left lateral decubitus position, but the total estimated blood loss in the prone position was significantly lower. There was no difference in the incidence of postoperative complications between the two procedures.

Conclusions: A thoracoscopic esophagectomy in the prone position is technically safe and feasible and provides better surgeon ergonomics and better operative exposure around the left recurrent laryngeal nerve during an aggressive esophagectomy.

Citing Articles

Left recurrent nerve lymph node dissection in robotic esophagectomy for esophageal cancer without esophageal traction.

Nakanoko T, Kimura Y, Natsugoe K, Nonaka K, Nambara S, Hu Q World J Surg Oncol. 2023; 21(1):223.

PMID: 37491241 PMC: 10369715. DOI: 10.1186/s12957-023-03117-3.

A comparison of two methods of lymph node dissection along the left recurrent laryngeal nerve in McKeown minimally invasive esophagectomy.

Zhu Z, Luo R, Li Z, He Z, Xu Y, Xu S J Gastrointest Oncol. 2023; 14(1):29-39.

PMID: 36915437 PMC: 10007940. DOI: 10.21037/jgo-22-1273.

Robot-Assisted Minimally Invasive Esophagectomy versus Open Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis.

Esagian S, Ziogas I, Skarentzos K, Katsaros I, Tsoulfas G, Molena D Cancers (Basel). 2022; 14(13).

PMID: 35804949 PMC: 9264782. DOI: 10.3390/cancers14133177.

A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer.

Sasaki K, Tsuruda Y, Shimonosono M, Noda M, Uchikado Y, Arigami T Surg Today. 2022; 52(12):1759-1765.

PMID: 35552816 DOI: 10.1007/s00595-022-02509-4.

Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy.

Zhao L, He J, Qin Y, Liu H, Li S, Han Z Dis Esophagus. 2021; 35(7).

PMID: 34864953 PMC: 9277452. DOI: 10.1093/dote/doab080.

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