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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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| Published in: | Langenbeck's archives of surgery 2019-05, Vol.404 (3), p.359-367 |
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| creator | 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 |
| description | 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
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| doi_str_mv | 10.1007/s00423-019-01772-3 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2189528213</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2189528213</sourcerecordid><originalsourceid>FETCH-LOGICAL-c347t-23c487b7ec27456c2a5b32fb5883cbae11d6bb2bff1cdada90c83483f5cf5c923</originalsourceid><addsrcrecordid>eNp9kLtOwzAUhi0EolB4AQaUkSXgW2pnRBU3qYgFZss-cVpXSRzsZOjb45LSEcn2sY6_81v6ELoh-J5gLB4ixpyyHJMybSFozk7QBeGsyCkvyOnxztkMXca4xRgvRMnP0YxhyUVRygu0freV002m-z54DZus9iGLowEdXJf6za7tN7qynYXBt7usGlN_nQ0bHzT4CL53kNnoE7Q-IK5LzzZLeV06fXSD890VOqt1E-31oc7R1_PT5_I1X328vC0fVzkwLoacMuBSGGGBCl4sgOrCMFqbQkoGRltCqoUx1NQ1gUpXusQgGZesLiCtkrI5upty0_ffo42Dal0E2zS6s36MihJZFlRSwhJKJxSCjzHYWvXBtTrsFMFqL1hNglUSrH4Fq_3Q7SF_NK2tjiN_RhPAJiD2e1M2qK0fQ1IZ_4v9AYOriVU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2189528213</pqid></control><display><type>article</type><title>Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position</title><source>Springer Link</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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
< 0.0001) and operative blood loss (123 ± 108 vs 207 ± 162 ml,
p
= 0.046) comparing with conventional approach. The incidence of postoperative pneumonia was lower in the medial approach group (4%) than in the conventional approach group (15%) (
p
= 0.069).
Conclusions
The medial approach for lymphadenectomy around the subcarina and both main bronchi during TEP is technically safe and feasible in shorting the operative time with possibility to reduce postoperative pneumonia.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-019-01772-3</identifier><identifier>PMID: 30847598</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>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</subject><ispartof>Langenbeck's archives of surgery, 2019-05, Vol.404 (3), p.359-367</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c347t-23c487b7ec27456c2a5b32fb5883cbae11d6bb2bff1cdada90c83483f5cf5c923</citedby><cites>FETCH-LOGICAL-c347t-23c487b7ec27456c2a5b32fb5883cbae11d6bb2bff1cdada90c83483f5cf5c923</cites><orcidid>0000-0003-0635-3432</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30847598$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oshikiri, Taro</creatorcontrib><creatorcontrib>Takiguchi, Gosuke</creatorcontrib><creatorcontrib>Miura, Susumu</creatorcontrib><creatorcontrib>Hasegawa, Hiroshi</creatorcontrib><creatorcontrib>Yamamoto, Masashi</creatorcontrib><creatorcontrib>Kanaji, Shingo</creatorcontrib><creatorcontrib>Yamashita, Kimihiro</creatorcontrib><creatorcontrib>Matsuda, Takeru</creatorcontrib><creatorcontrib>Nakamura, Tetsu</creatorcontrib><creatorcontrib>Fujino, Yasuhiro</creatorcontrib><creatorcontrib>Tominaga, Masahiro</creatorcontrib><creatorcontrib>Suzuki, Satoshi</creatorcontrib><creatorcontrib>Kakeji, Yoshihiro</creatorcontrib><title>Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>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
< 0.0001) and operative blood loss (123 ± 108 vs 207 ± 162 ml,
p
= 0.046) comparing with conventional approach. The incidence of postoperative pneumonia was lower in the medial approach group (4%) than in the conventional approach group (15%) (
p
= 0.069).
Conclusions
The medial approach for lymphadenectomy around the subcarina and both main bronchi during TEP is technically safe and feasible in shorting the operative time with possibility to reduce postoperative pneumonia.</description><subject>Abdominal Surgery</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Carcinoma, Squamous Cell - surgery</subject><subject>Cardiac Surgery</subject><subject>Case-Control Studies</subject><subject>Dissection</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy - methods</subject><subject>Female</subject><subject>General Surgery</subject><subject>How-I-Do-It article</subject><subject>Humans</subject><subject>Lymph Node Excision - methods</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Prone Position</subject><subject>Retrospective Studies</subject><subject>Thoracic Surgery</subject><subject>Thoracoscopy - methods</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kLtOwzAUhi0EolB4AQaUkSXgW2pnRBU3qYgFZss-cVpXSRzsZOjb45LSEcn2sY6_81v6ELoh-J5gLB4ixpyyHJMybSFozk7QBeGsyCkvyOnxztkMXca4xRgvRMnP0YxhyUVRygu0freV002m-z54DZus9iGLowEdXJf6za7tN7qynYXBt7usGlN_nQ0bHzT4CL53kNnoE7Q-IK5LzzZLeV06fXSD890VOqt1E-31oc7R1_PT5_I1X328vC0fVzkwLoacMuBSGGGBCl4sgOrCMFqbQkoGRltCqoUx1NQ1gUpXusQgGZesLiCtkrI5upty0_ffo42Dal0E2zS6s36MihJZFlRSwhJKJxSCjzHYWvXBtTrsFMFqL1hNglUSrH4Fq_3Q7SF_NK2tjiN_RhPAJiD2e1M2qK0fQ1IZ_4v9AYOriVU</recordid><startdate>20190501</startdate><enddate>20190501</enddate><creator>Oshikiri, Taro</creator><creator>Takiguchi, Gosuke</creator><creator>Miura, Susumu</creator><creator>Hasegawa, Hiroshi</creator><creator>Yamamoto, Masashi</creator><creator>Kanaji, Shingo</creator><creator>Yamashita, Kimihiro</creator><creator>Matsuda, Takeru</creator><creator>Nakamura, Tetsu</creator><creator>Fujino, Yasuhiro</creator><creator>Tominaga, Masahiro</creator><creator>Suzuki, Satoshi</creator><creator>Kakeji, Yoshihiro</creator><general>Springer Berlin Heidelberg</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0635-3432</orcidid></search><sort><creationdate>20190501</creationdate><title>Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-23c487b7ec27456c2a5b32fb5883cbae11d6bb2bff1cdada90c83483f5cf5c923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdominal Surgery</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Carcinoma, Squamous Cell - surgery</topic><topic>Cardiac Surgery</topic><topic>Case-Control Studies</topic><topic>Dissection</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy - methods</topic><topic>Female</topic><topic>General Surgery</topic><topic>How-I-Do-It article</topic><topic>Humans</topic><topic>Lymph Node Excision - methods</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Prone Position</topic><topic>Retrospective Studies</topic><topic>Thoracic Surgery</topic><topic>Thoracoscopy - methods</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oshikiri, Taro</creatorcontrib><creatorcontrib>Takiguchi, Gosuke</creatorcontrib><creatorcontrib>Miura, Susumu</creatorcontrib><creatorcontrib>Hasegawa, Hiroshi</creatorcontrib><creatorcontrib>Yamamoto, Masashi</creatorcontrib><creatorcontrib>Kanaji, Shingo</creatorcontrib><creatorcontrib>Yamashita, Kimihiro</creatorcontrib><creatorcontrib>Matsuda, Takeru</creatorcontrib><creatorcontrib>Nakamura, Tetsu</creatorcontrib><creatorcontrib>Fujino, Yasuhiro</creatorcontrib><creatorcontrib>Tominaga, Masahiro</creatorcontrib><creatorcontrib>Suzuki, Satoshi</creatorcontrib><creatorcontrib>Kakeji, Yoshihiro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oshikiri, Taro</au><au>Takiguchi, Gosuke</au><au>Miura, Susumu</au><au>Hasegawa, Hiroshi</au><au>Yamamoto, Masashi</au><au>Kanaji, Shingo</au><au>Yamashita, Kimihiro</au><au>Matsuda, Takeru</au><au>Nakamura, Tetsu</au><au>Fujino, Yasuhiro</au><au>Tominaga, Masahiro</au><au>Suzuki, Satoshi</au><au>Kakeji, Yoshihiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2019-05-01</date><risdate>2019</risdate><volume>404</volume><issue>3</issue><spage>359</spage><epage>367</epage><pages>359-367</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>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
< 0.0001) and operative blood loss (123 ± 108 vs 207 ± 162 ml,
p
= 0.046) comparing with conventional approach. The incidence of postoperative pneumonia was lower in the medial approach group (4%) than in the conventional approach group (15%) (
p
= 0.069).
Conclusions
The medial approach for lymphadenectomy around the subcarina and both main bronchi during TEP is technically safe and feasible in shorting the operative time with possibility to reduce postoperative pneumonia.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30847598</pmid><doi>10.1007/s00423-019-01772-3</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-0635-3432</orcidid></addata></record> |
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| 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 |
| title | Medial approach for subcarinal lymphadenectomy during thoracoscopic esophagectomy in the prone position |
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