Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position

Purpose In esophageal squamous cell carcinoma (ESCC), lymph nodes (LNs) around the subcarina and main bronchi are thought to be highly involved. Therefore, complete dissection of these LNs with preservation of the pulmonary branches of the vagus nerves, which control important pulmonary functions, i...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2019-05, Vol.404 (3), p.359-367
Main Authors: Oshikiri, Taro, Takiguchi, Gosuke, Miura, Susumu, Hasegawa, Hiroshi, Yamamoto, Masashi, Kanaji, Shingo, Yamashita, Kimihiro, Matsuda, Takeru, Nakamura, Tetsu, Fujino, Yasuhiro, Tominaga, Masahiro, Suzuki, Satoshi, Kakeji, Yoshihiro
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adolescent
Adult
Aged
Carcinoma, Squamous Cell - surgery
Cardiac Surgery
Case-Control Studies
Dissection
Esophageal Neoplasms - surgery
Esophagectomy - methods
Female
General Surgery
How-I-Do-It article
Humans
Lymph Node Excision - methods
Male
Medicine
Medicine & Public Health
Middle Aged
Prone Position
Retrospective Studies
Thoracic Surgery
Thoracoscopy - methods
Traumatic Surgery
Vascular Surgery
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Summary:Purpose In esophageal squamous cell carcinoma (ESCC), lymph nodes (LNs) around the subcarina and main bronchi are thought to be highly involved. Therefore, complete dissection of these LNs with preservation of the pulmonary branches of the vagus nerves, which control important pulmonary functions, is recommended. The aim of this retrospective study was to investigate the feasibility of reliable method for lymphadenectomy around the subcarina and main bronchi, named the medial approach, during thoracoscopic esophagectomy in the prone position (TEP). Methods This was a case-matched control study of patients who underwent TEP for ESCC. The fundamental concept in this method is to first exfoliate the LNs around the subcarina and main bronchi from the pericardium. Developing the operative field contributes to visualizing and preserving the pulmonary branches of the right vagus nerve. Twenty-three patients who underwent the medial approach and 23 patients who underwent the conventional approach were selected by the use of propensity score matching to compare the operative outcomes. Results The medial approach significantly reduced operative time for procedure (16 ± 3 vs 30 ± 6 min, p  
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-019-01772-3