Abstract
Background
In esophageal cancer, lymph nodes along the recurrent laryngeal nerves (RLNs) are thought to be highly involved. Complete dissection of these lymph nodes is recommended but there is limited working space in the left upper mediastinum and advanced dissection skills are required. We present herein a new method for lymphadenectomy along the left RLN, called the Bascule method during prone esophagectomy.
Methods
The fundamental concept of this new method is to draw the proximal portion of the divided esophagus and tissue that includes the left RLN and lymph nodes through a gap between the vertebral body and the right scapula. Using this technique, a two-dimensional membrane, similar to the “esophageal mesenteriolum” (lateral pedicle), will be easily recognizable. Identification and reliable cutting of the tracheoesophageal artery and distinguishing the left RLN from the lymph nodes should be easy. This technique was evaluated in 39 consecutive cases of prone esophagectomy for squamous cell cancer.
Results
There were 18 patients who underwent the new method (Bascule method; Bm) and 21 patients who underwent the conventional method (Cm). The duration of the thoracic procedure and dissection along the left RLN was significantly shorter in Bm group than in Cm group (258 ± 30 vs. 291 ± 39 min; p = 0.007 and 66 ± 9 vs. 75 ± 14 min; p = 0.036, respectively). Estimated blood loss in Bm group was 20 ± 11 g compared to 38 ± 32 g in Cm group (p = 0.028). No intraoperative morbidity related to the left RLN was observed in either group. The hoarseness rate in Bm group was 28 %, which was lower than that in the Cm group (48 %).
Conclusions
The Bascule method for lymphadenectomy along the left RLN during prone esophagectomy is technically safe and feasible and reduces operative time and blood loss.
Similar content being viewed by others
References
Jianyuan Chai M, Jamal Mazen (2012) Esophageal malignancy: a growing concern. World J Gastroenterol 18:6521–6526
Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y (1994) Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg 220:364–372
Watson A (1994) Operable esophageal cancer: current results from the West. World J Surg 18:361–366
Watanabe H, Kato H, Tachimori Y (2000) Significance of extended systemic lymph node dissection for thoracic esophageal carcinoma in Japan. Recent Results Cancer Res 155:123–133
Shiozaki H, Yano M, Tsujinaka T, Inoue M, Tamura S, Doki Y, Yasuda T, Fujiwara Y, Monden M (2001) Lymph node metastasis along the recurrent nerve chain is an indication for cervical lymph node dissection in thoracic esophageal cancer. Dis Esophagus 14:191–196
Tsurumaru M, Kajiyama Y, Udagawa H, Akiyama H (2001) Outcomes of extensive lymph node dissection for squamous cell carcinoma of the thoracic esophagus. Ann Thoracic Cardiovasc Surg 7:325–329
Nishimaki T, Suzuki T, Tanaka Y, Nakagawa S, Aizawa K, Hatakeyama K (1997) Evaluating the rational extent of dissection in radical esophagectomy for invasive carcinoma of the thoracic esophagus. Surg Today 27:3–8
Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11
Palanivelu C, Prakash A, Senthikumar R, Senthilnathan P, Parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position experience of 130 patients. J Am Coll Surg 203:7–16
Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, Koike K, Miyazaki K (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24:2965–2973
Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724
Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H (2003) A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 90:108–113
Salassa JR, Pearson BW, Payne WS (1977) Gross and microscopical blood supply of the trachea. Ann Thorac Surg 24:100–107
Disclosures
Taro Oshikiri, Takashi Yasuda, Hitoshi Harada, Hironobu Goto, Masato Oyama, Hiroshi Hasegawa, Tadayuki Ohara, Hiroyoshi Sendo, Tetsu Nakamura, Yasuhiro Fujino, Masahiro Tominaga, and Yoshihiro Kakeji have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Oshikiri, T., Yasuda, T., Harada, H. et al. A new method (the “Bascule method”) for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer. Surg Endosc 29, 2442–2450 (2015). https://doi.org/10.1007/s00464-014-3919-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-014-3919-6