Bernadette Schurink1, Ingmar L Defize1, Elena Mazza2, Jelle P Ruurda2, Lodewijk A A Brosens3, Tom A P Roeling4, Ronald L A W Bleys4, Richard van Hillegersberg5. 1. Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 2. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 3. Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 4. Department of Anatomy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 5. Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: r.vanhillegersberg@umcutrecht.nl.
Abstract
BACKGROUND: Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct. METHODS: A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically. RESULTS: Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present. CONCLUSIONS: This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.
BACKGROUND: Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct. METHODS: A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically. RESULTS: Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present. CONCLUSIONS: This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.
Authors: I L Defize; S van der Horst; M Bülbul; N Haj Mohammad; S Mook; G J Meijer; L A A Brosens; J P Ruurda; R van Hillegersberg Journal: Ann Surg Oncol Date: 2020-12-19 Impact factor: 5.344
Authors: Jessica M Leers; Laura Knepper; Arjen van der Veen; Wolfgang Schröder; Hans Fuchs; Petra Schiller; Martin Hellmich; Ulrike Zettelmeyer; Lodewijk A A Brosens; Alexander Quaas; Jelle P Ruurda; Richard van Hillegersberg; Christiane J Bruns Journal: BMC Cancer Date: 2020-08-20 Impact factor: 4.430