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Upper mediastinal lymph node dissection based on mesenteric excision in esophageal cancer surgery: confirmation by near-infrared image-guided lymphatic mapping and the impact on locoregional control

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Abstract

Background

We previously reported a novel method of mesenteric excision for esophageal cancer surgery. The esophagus, trachea, recurrent laryngeal nerves (RLNs), and surrounding lymph nodes (LNs) are contained in a common mesenterium, which we termed the “mesotracheoesophagus”. In addition, near-infrared (NIR) image-guided lymphatic mapping has recently been used. The purpose of this study was to confirm the feasibility of NIR image-guided lymphatic mapping for upper mediastinal LN dissection, and to confirm the oncological feasibility of our surgical approach.

Methods

Fifteen patients with resectable esophageal cancer underwent submucosal injection of indocyanine green (ICG), and underwent robot-assisted esophagectomy. The frequency of ICG positivity in the LN basins along the RLNs, and metastatic frequency were assessed. Regarding the oncological feasibility of our thoracoscopic esophagectomy, the recurrence patterns and survival of 72 consecutive patients who underwent curative resection from 2011 to 2016 were analyzed.

Results

ICG-positive LN basins along the right and left RLNs were found in 12 (80% of 15) patients (3 patients positive for metastatic LNs) and 11 (73% of 15) patients (2 positive for metastatic LNs and 1 false-negative), respectively. All ICG-positive LN basins were found within the mesotracheoesophagus. The sensitivity was 5/6 (83%), and the negative predictive value was 6/7 (86%). Among the 72 patients, with a median follow-up period of 1644 days, only 3 (4.2%) patients developed locoregional recurrence.

Conclusions

The NIR image-guided lymphatic mapping was feasible. Our results with no ICG-positive basins outside of the ‘”mesotracheoesophagus”, supported our surgical approach. It might become standard, with acceptable locoregional control.

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Author notes

  1. Hisahiro Hosogi and Daisuke Yagi have contributed equally to the work.

Authors and Affiliations

  1. Department of Surgery, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, 543-8555, Japan

    Hisahiro Hosogi, Daisuke Yagi, Masazumi Sakaguchi, Shin Akagawa, Yukinari Tokoro & Seiichiro Kanaya

  2. Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Shin Akagawa

Authors
  1. Hisahiro Hosogi
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  2. Daisuke Yagi
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  3. Masazumi Sakaguchi
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  4. Shin Akagawa
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  5. Yukinari Tokoro
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  6. Seiichiro Kanaya
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Corresponding author

Correspondence to Hisahiro Hosogi.

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All authors have no conflicts of interest or financial ties to disclose.

Ethical Statement

All the studies were conducted in accordance with the ethics of the Declaration of Helsinki, and approved by the ethics committee of Japanese Red Cross Osaka Hospital (IRB J-0124). In the preoperative ICG injection study, written informed consent was obtained from all the patients. The requirements to obtain individual patient consent in the NIR image-guided lymphatic mapping study and the mid- to long-term study were waived given the retrospective nature of the studies.

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Hosogi, H., Yagi, D., Sakaguchi, M. et al. Upper mediastinal lymph node dissection based on mesenteric excision in esophageal cancer surgery: confirmation by near-infrared image-guided lymphatic mapping and the impact on locoregional control. Esophagus 18, 219–227 (2021). https://doi.org/10.1007/s10388-020-00789-8

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  • DOI: https://doi.org/10.1007/s10388-020-00789-8

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