Spatial relationships of the bronchial arteries to the left recurrent laryngeal nerve in the sub-aortic arch area

Two-rope method for dissecting esophagus in McKeown MIE

Objective

Minimally invasive McKeown esophagectomy (McKeown MIE) is performed at many hospitals in esophageal cancer(EC) treatment. However, secure and quick methods for dissecting the esophagus and dissecting lymph nodes in this surgery are lacking. This study introduces a simple, secure and feasible esophagus dissecting technique named two-rope method. Two mobile traction ropes are placed around the esophagus and we tow these ropes to free the esophagus, dissect the lymph nodes, and decrease the operative trauma.

Materials and Methods

Retrospective analysis was performed on 112 patients who underwent McKeown MIE in our center from January 2019 to September 2021. They were assigned into two groups based on the method of dissecting the esophagus: Group A (two-rope method, 45 cases) and Group B (regular method, 67 cases). Operation time, thoracic operation time, the number of dissected thoracic lymph nodes, and postoperative complications were compared between the two groups after propensity score matching.

Results

Using 1:1 nearest neighbor matching, we successfully matched 41 pairs of patients. Operation time, thoracic operation time, and the duration (ac to as) was significantly shorter and the size of the abdominal incision was significantly smaller in the Group A than Group B (p < 0.05). There was no statistically significant difference in the number of dissected thoracic lymph nodes, pulmonary infection, anastomotic leak, recurrent laryngeal (RLN) injury, and chylothorax between the two groups (p > 0.05).

Conclusions

Two-rope method to free the esophagus and dissect thoracic lymph nodes in McKeown MIE has significant advantages compared with the regular method. The technique is, therefore suitable for widespread adoption by surgeons.

Application of esophageal wire traction in lymph node dissection during three-hole thoracoscopic McKeown esophagectomy

INTRODUCTION

The quality of left recurrent laryngeal nerve lymph node dissection is critical in esophageal cancer. We investigated whether esophageal wire traction in three-hole thoracoscopic esophagectomy can improve the same.

MATERIAL AND METHODS

We retrospectively analyzed the data of 98 patients who underwent thoracoscopic esophagectomy in our center from January 2018 to July 2018: 36 patients with esophageal wire traction and 62 patients without traction (control group). The clearance time for left recurrent laryngeal nerve lymph nodes, thoracic bleeding volume, number of left recurrent laryngeal nerve lymph nodes, and complications were recorded.

RESULTS

The observation group had a shorter clearance time for the left recurrent laryngeal nerve lymph nodes (15.8 ± 6.9 min vs. 20.00 ± 6.2 min), less thoracic bleeding (55.8 ± 30.2 mL vs. 70.7 ± 30.3 mL), and higher number of dissected left recurrent laryngeal lymph nodes (3.3 ± 1.4 vs. 2.5 ± 1.1) than the control group. There was no significant difference in the incidence of anastomotic leakage, pulmonary infection, arrhythmia, chylothorax, and nerve injury.

CONCLUSIONS

Esophageal wire traction shortens the clearance time for the left recurrent laryngeal nerve lymph nodes, reduces thoracic bleeding, and improves the quality of left recurrent laryngeal nerve lymph node dissection in three-hole thoracoscopic esophagectomy.