BACKGROUND: In esophageal squamous cell carcinoma, the number of dissected lymph nodes (LNs), including those along the recurrent laryngeal nerves (RLNs), influences prognosis and nodal staging accuracy. However, dissection of LNs along the RLN increases the risk of complications, especially RLN palsy. Therefore, complete dissection of these LNs with prevention of RLN palsy is recommended. We present herein a new method for lymphadenectomy along the right RLN, named the Pincers maneuver, during thoracoscopic esophagectomy in the prone position (TEP). METHODS: The fundamental concept in this new method is to first exfoliate the two-dimensional membrane (lateral pedicle), which includes the right RLN, LNs along the right RLN, and the primary esophageal artery, from the right side of the trachea toward the neck. Using a Pincers strategy, closing in from the inner and outer sides of the two-dimensional membrane (lateral pedicle), lymphadenectomy along the right RLN toward the right inferior thyroid artery should be easy. This technique was evaluated in 30 consecutive cases of TEP for squamous cell cancer. RESULTS: There were 15 patients who underwent the new method (Pincers maneuver; Pm) and 15 patients who underwent the conventional method (Cm). There were no significant differences between the two groups in the duration of the thoracic procedure and dissection along the right RLN. No intraoperative and postoperative morbidity related to the right RLN was observed in either group. The Pm group had a higher number of dissected LNs along the right RLN than the Cm group (6.3 vs 3.1, p = 0.044). CONCLUSIONS: The Pincers maneuver for lymphadenectomy along the right RLN during TEP is technically safe and feasible. It increases the number of dissected LNs along the right RLN.
BACKGROUND: In esophageal squamous cell carcinoma, the number of dissected lymph nodes (LNs), including those along the recurrent laryngeal nerves (RLNs), influences prognosis and nodal staging accuracy. However, dissection of LNs along the RLN increases the risk of complications, especially RLN palsy. Therefore, complete dissection of these LNs with prevention of RLN palsy is recommended. We present herein a new method for lymphadenectomy along the right RLN, named the Pincers maneuver, during thoracoscopic esophagectomy in the prone position (TEP). METHODS: The fundamental concept in this new method is to first exfoliate the two-dimensional membrane (lateral pedicle), which includes the right RLN, LNs along the right RLN, and the primary esophageal artery, from the right side of the trachea toward the neck. Using a Pincers strategy, closing in from the inner and outer sides of the two-dimensional membrane (lateral pedicle), lymphadenectomy along the right RLN toward the right inferior thyroid artery should be easy. This technique was evaluated in 30 consecutive cases of TEP for squamous cell cancer. RESULTS: There were 15 patients who underwent the new method (Pincers maneuver; Pm) and 15 patients who underwent the conventional method (Cm). There were no significant differences between the two groups in the duration of the thoracic procedure and dissection along the right RLN. No intraoperative and postoperative morbidity related to the right RLN was observed in either group. The Pm group had a higher number of dissected LNs along the right RLN than the Cm group (6.3 vs 3.1, p = 0.044). CONCLUSIONS: The Pincers maneuver for lymphadenectomy along the right RLN during TEP is technically safe and feasible. It increases the number of dissected LNs along the right RLN.
Entities:
Keywords:
Esophageal carcinoma; Lateral pedicle; Lymphadenectomy; Pincers maneuver; Right recurrent laryngeal nerve; Thoracoscopic esophagectomy in the prone position
Authors: H Shiozaki; M Yano; T Tsujinaka; M Inoue; S Tamura; Y Doki; T Yasuda; Y Fujiwara; M Monden Journal: Dis Esophagus Date: 2001 Impact factor: 3.429
Authors: Nasser K Altorki; Xi Kathy Zhou; Brendon Stiles; Jeffrey L Port; Subroto Paul; Paul C Lee; Madhu Mazumdar Journal: Ann Surg Date: 2008-08 Impact factor: 12.969
Authors: Nabil P Rizk; Hemant Ishwaran; Thomas W Rice; Long-Qi Chen; Paul H Schipper; Kenneth A Kesler; Simon Law; Toni E M R Lerut; Carolyn E Reed; Jarmo A Salo; Walter J Scott; Wayne L Hofstetter; Thomas J Watson; Mark S Allen; Valerie W Rusch; Eugene H Blackstone Journal: Ann Surg Date: 2010-01 Impact factor: 12.969