Advertisement

World Journal of Surgery

, Volume 42, Issue 2, pp 590–598 | Cite as

Lymph Node Evaluation in Robot-Assisted Versus Video-Assisted Thoracoscopic Esophagectomy for Esophageal Squamous Cell Carcinoma: A Propensity-Matched Analysis

  • Yin-Kai ChaoEmail author
  • Ming-Ju Hsieh
  • Yun-Hen Liu
  • Hui-Ping Liu
Original Scientific Report with Video

Abstract

Objective

Radical lymph node dissection (LND) along the bilateral recurrent laryngeal nerve (RLN) is a surgically challenging procedure with a high rate of morbidity. Here, we assessed in a retrospective manner the adequacy of LND along the RLN performed with robot-assisted thoracoscopic esophagectomy (RATE) versus video-assisted thoracoscopic esophagectomy (VATE) in patients with esophageal squamous cell carcinoma (ESCC).

Methods

This was a single-center, retrospective, propensity-matched study. ESCC patients who underwent McKeown esophagectomy and bilateral RLN LND with a minimally invasive approach were divided into two groups according to the use of robot-assisted surgery or not (RATE vs VATE, respectively). Using propensity score matching, 34 balanced matched pairs were identified. The number of dissected nodes as well as the rates of RLN palsy and perioperative complications served as the main outcome measures.

Results

No conversion to open thoracotomy occurred in either group. Intraoperative blood loss and the need of blood transfusions did not show significant intergroup differences. The mean number of dissected nodes was similar in the two study groups, the only exception being the left RLN area. Specifically, the mean number of nodes removed from this region was 5.32 in the RATE group and 3.38 in patients who received VATE (p = 0.007). Notably, the RATE and VATE groups did not differ significantly with regard to rates of both RLN palsy (20.6 vs 29.4%, respectively, p = 0.401) and pulmonary complications (5.9 vs 17.6%, respectively, p = 0.259).

Conclusions

Compared with VATE, RATE resulted in a higher lymph node yield along the left RLN without increasing morbidity.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

Clip 1. Operating video illustrating the RATE approach, with a special focus on bilateral recurrent laryngeal nerve lymph node dissection. (MP4 65098 kb)

Clip 2. Operating video illustrating the VATE approach, with a special focus on the potential difficulties that can be encountered during recurrent laryngeal nerve lymph node dissection on the left side. (MP4 26570 kb)

References

  1. 1.
    Tachimori Y, Ozawa S, Numasaki H et al (2016) Efficacy of lymph node dissection for each station based on esophageal tumor location. Esophagus 13:138–145CrossRefGoogle Scholar
  2. 2.
    Udagawa H, Ueno M, Shinohara H et al (2012) The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol 106:742–747CrossRefPubMedGoogle Scholar
  3. 3.
    Mizutani M, Murakami G, S-I Nawata et al (2006) Anatomy of right recurrent nerve node: why does early metastasis of esophageal cancer occur in it? Surg Radiol Anat 28:333–338CrossRefPubMedGoogle Scholar
  4. 4.
    Sato Y, Kosugi S-I, Aizawa N et al (2016) Risk factors and clinical outcomes of recurrent laryngeal nerve paralysis after esophagectomy for thoracic esophageal carcinoma. World J Surg 40:129–136. doi: 10.1007/s00268-015-3261-8 CrossRefPubMedGoogle Scholar
  5. 5.
    Fujita H, Sueyoshi S, Tanaka T et al (2003) Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short-and long-term outcome among the four types of lymphadenectomy. World J Surg 27:571–579. doi: 10.1007/s00268-003-6913-z CrossRefPubMedGoogle Scholar
  6. 6.
    Gockel I, Kneist W, Keilmann A et al (2005) Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma. Eur J Surg Oncol (EJSO) 31:277–281CrossRefGoogle Scholar
  7. 7.
    Berry MF, Atkins BZ, Tong BC et al (2010) A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia. J Thorac Cardiovasc Surg 140:1266–1271CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hulscher JB, van Sandick JW, Devriese P et al (1999) Vocal cord paralysis after subtotal oesophagectomy. Br J Surg 86:1583–1587CrossRefPubMedGoogle Scholar
  9. 9.
    Luketich JD, Pennathur A, Awais O et al (2012) Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg 256:95–103CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Zhou C, Zhang L, Wang H et al (2015) Superiority of minimally invasive oesophagectomy in reducing in-hospital mortality of patients with resectable oesophageal cancer: a meta-analysis. PloS ONE 10:e0132889CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Biere SS, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892CrossRefPubMedGoogle Scholar
  12. 12.
    Noshiro H, Iwasaki H, Kobayashi K et al (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24:2965–2973CrossRefPubMedGoogle Scholar
  13. 13.
    Park S, Kim D, Yu W et al (2015) Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer. Dis Esophagus 29:326–332CrossRefPubMedGoogle Scholar
  14. 14.
    Van der Sluis P, Ruurda J, Verhage R et al (2015) Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol 22:1350–1356CrossRefPubMedCentralGoogle Scholar
  15. 15.
    Cerfolio RJ, Wei B, Hawn MT et al (2015) Robotic esophagectomy for cancer: early results and lessons learned seminars in thoracic and cardiovascular surgery. Elsevier, AmsterdamGoogle Scholar
  16. 16.
    Suda K, Ishida Y, Kawamura Y et al (2012) Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg 36:1608–1616. doi: 10.1007/s00268-012-1538-8 CrossRefPubMedGoogle Scholar
  17. 17.
    Weksler B, Sharma P, Moudgill N et al (2012) Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Dis Esophagus 25:403–409CrossRefPubMedGoogle Scholar
  18. 18.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  19. 19.
    Low DE, Alderson D, Cecconello I et al (2015) International consensus on standardization of data collection for complications associated with esophagectomy: esophagectomy Complications Consensus Group (ECCG). Ann Surg 262:286–294CrossRefPubMedGoogle Scholar
  20. 20.
    Fang T-J, Hsin L-J, Chung H-F et al (2015) Office-based intracordal hyaluronate injections improve quality of life in thoracic-surgery-related unilateral vocal fold paralysis. Medicine 94:e1787CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Xi Y, Ma Z, Shen Y et al (2016) A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma. J Thoracic Dis 8:24Google Scholar
  22. 22.
    Zhang R, Liu S, Sun H et al (2014) The application of single-lumen endotracheal tube anaesthesia with artificial pneumothorax in thoracolaparoscopic oesophagectomy. Interact Cardiovasc Thorac Surg 19:308–331CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Yin-Kai Chao
    • 1
    Email author
  • Ming-Ju Hsieh
    • 1
  • Yun-Hen Liu
    • 1
  • Hui-Ping Liu
    • 1
  1. 1.Division of Thoracic Surgery, Chang Gung Memorial Hospital-LinkoChang Gung UniversityTaoyuanTaiwan

Personalised recommendations