Ivor Lewis subtotal esophagectomy with two-field lymphadenectomy for squamous cell carcinoma of the lower thoracic esophagus

Does recurrent laryngeal nerve lymph node metastasis really affect the prognosis in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus?

Background

Recurrent laryngeal nerve (RLN) lymph node metastasis used to be shown a predictor for poor prognosis in esophageal squamous cell carcinoma. The purpose of this study was to evaluate the prognostic impact of RLN node metastasis and the number of metastatic lymph nodes in node-positive patients with squamous cell carcinoma of middle thoracic esophagus.

Methods

A cohort of 235 patients who underwent curative surgery for squamous cell carcinoma of middle thoracic esophagus was investigated. The prognostic impact was evaluated by univariate and multivariate analyses.

Results

Lymph node metastasis was found in 133 patients. Among them, 81 had metastatic RLN nodes, and 52 had at least one positive node but no RLN nodal involvement. The most significant difference in survival was detected between patients with metastatic lymph nodes below and above a cutoff value of six (P < 0.001). Multivariate analysis revealed that the number of metastatic lymph nodes was a significant factor associated with overall survival (P < 0.001), but RLN lymph node metastasis was not (P = 0.865).

Conclusions

RLN Lymph node metastasis is not, but the number of metastatic nodes is a prognostic predictor in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus.

The sweet approach is still worthwhile in modern esophagectomy

BACKGROUND

The Ivor Lewis and Sweet approaches are the two most widely used open transthoracic esophagectomy techniques. We evaluated and compared the therapeutic efficacy of these two approaches to determine the appropriate method to treat middle or lower third esophageal carcinomas.

METHODS

We retrospectively reviewed patients who underwent esophagectomy with the Sweet (n=748) and Ivor Lewis (n=167) approaches at Zhongshan Hospital, Fudan University between January 2007 and December 2010. Patients with preoperatively identified superior mediastinal lymph node metastases, high-level lesions (above the carina), and benign tumors were excluded. Perioperative-related indicators and 5-year survival rates were compared between groups.

RESULTS

Compared with the Ivor Lewis approach, the Sweet approach has a shorter operative time (181±71 minutes versus 208±63 minutes; p<0.001), less blood loss (167±71 mL versus 179±87 mL; p=0.043), and a lower incidence of transfusion (8.7% versus 13.8%; p=0.044) and postoperative complications (12.3% versus 20.4%; p=0.002). The Ivor Lewis approach was more likely to result in wound infection (3.2% versus 7.8%; p=0.010) and delayed gastric emptying (1.7% versus 4.7%; p=0.046). There was no significant difference between groups with regard to the number of lymph nodes harvested or total number of patients with lymph node metastases. There was no significant difference in locoregional recurrence, distant recurrence, or 5-year survival between approaches.

CONCLUSIONS

The Sweet approach has many advantages for the treatment of middle or lower third esophageal carcinomas. It is a safe, effective, and worthwhile approach in modern thoracic surgery.

The use of LigaSure Vessel Sealing System in Ivor Lewis esophagectomy

Background

This study investigated the results of the LigaSure Vessel Sealing System (LVSS), which has been routinely used in esophageal resections in our clinic since 2006.

Methods

For this purpose, 60 patients who underwent Ivor Lewis esophagectomy were included in the study. The results were compared with the patients who underwent stomach mobilising procedure and esophagectomy with conventional methods (conventional group) before 2006 and the patients who underwent LVSS (group of LigaSure) in surgical cases after 2006. The cases were compared particularly in terms of intraoperative bleeding, operative time, duration of postoperative hospital stay, intraoperative complications, mortality, and morbidity.

Results

Of the patients, 34 (% 56.6) were female and 26 (43.3%) were male, and the range of the age was between 33 and 78, and the mean age of the patients was 52.73 ± 11,617. While the amount of intraoperative bleeding was 321.864 ± 575.00 ml in the conventional group, this was found to be 370.31 ± 238.456 ml in the LigaSure group (p = 0.007). In the statistical evaluation of the operative time, the mean duration was determined as 310.00 ± 24.795 minutes in the conventional group, whereas it was determined as 265.16 ± 31.353 minutes in the LigaSure group (p = 0.001).

Conclusions

The use of LVSS was associated with a significant reduction in the operative time and the rate of intra-operative complications.