Application of mediastinal lymph node dissection in inflatable video-assisted mediastinoscopic transhiatal esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Hanran , LIU Changqing , XIE Mingran , WU Xianning , WU Gao ,  MEI Xinyu

Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, P. R. China;

Corresponding?author：

MEI Xinyu, Email: mxyahslyy@163.com

Keywords：

Esophageal neoplasms; inflatable video-assisted mediastinoscopy; esophagectomy; lymph node dissection

DOI：

10.7507/1007-4848.202501021

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the feasibility, safety, and effectivity of the application of systematic lymph node dissection (SLND) in inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE). Methods The clinical data of the patients who underwent IVMTE for esophageal cancer in the First Affiliated Hospital of University of Science and Technology of China From January to October 2024 were restrospectively analyzed. They were divided into a SLND group and an elective lymph node dissection (ELND) group according to intraoperative lymph node resection. clinical characteristics and perioperative outcomes were compared between the two groups. Results A total of 66 patients were enrolled, including 51 males and 15 females, with a mean age of (70.13 ± 8.49) years. There were 12 patients in the selective lymph node dissection (SLND) group and 54 patients in the extended lymph node dissection (ELND) group. There were no statistical differences between the two groups in terms of age, sex, cT stage, tumor location, differentiation grade, pT stage, pN stage, and preoperative comorbidities (P>0.05). statistical differences were observed between the two groups in terms of receiving preoperative neoadjuvant therapy and pTNM staging (P<0.05). There were no statistical differences between the two groups in postoperative complications, operative time, intraoperative blood loss, postoperative hospital stay, and left recurrent laryngeal nerve paratracheal lymph node dissection (P>0.05). The SLND group had a higher average number of lymph nodes dissected, number of stations, number of mediastinal lymph nodes, and number of mediastinal stations than the ELND group. statistical differences were observed between the two groups in the dissection of paraesophageal, right recurrent laryngeal nerve, subcarinal, and diaphragmatic lymph nodes (P<0.05). There were no statistical differences between the two groups in mediastinal lymph node metastasis and cervical lymph node metastasis (P>0.05). The SLND group had more abdominal lymph node metastasis than the ELND group, and the difference was statistically significant (P=0.034). Univariate and multivariate logistic regression analysis showed that cervical lymph node dissection was a risk factor for postoperative complications (P=0.023). Conclusion SLND is safe and effective in IVMTE. Compared with the ELND group, it increased the number of lymph nodes and stations dissected in the mediastinum, and improved the accuracy of postoperative staging. Meanwhile, it did not prolong operative time or hospital stay, nor did it increase the risk of postoperative complications or non-surgical complications.

1.	王培宇, 黃祺, 王少東, 等. 《全球癌癥統計數據2022》要點解讀. 中國胸心血管外科臨床雜志, 2024, 31(7): 933-954.Wang PY, Huang Q, Wang SJ, et al. Interpretation of the key points of global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(7): 933-954.
2.	Igaue S, Fujita T, Oguma J, et al. Long-term survival in esophageal cancer: Comparison of minimally invasive and open esophagectomy. Ann Thorac Surg, 2025, 119(4): 805-814.
3.	Tokairin Y, Nakajima Y, Kawada K, et al. A feasibility study of mediastinoscopic radical esophagectomy for thoracic esophageal cancer from the viewpoint of the dissected mediastinal lymph nodes validated with thoracoscopic procedure: A prospective clinical trial. Esophagus, 2019, 16(2): 214-219.
4.	Liu C, Chen Z, Wei R, et al. Intra-operative events and countermeasures during esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy. J Thorac Dis, 2021, 13(1): 133-139.
5.	中華人民共和國國家衛生健康委員會醫政醫管局. 食管癌診療指南 (2022 年版). 中華消化外科雜志, 2022, 21(10): 1247-1268.Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Standardization for diagnosis and treatment of esophageal cancer (2022 edition). Chin J Dig Surg, 2022, 21(10): 1247-1268.
6.	Zhang Y, Deng C, Zheng Q, et al. Selective mediastinal lymph node dissection strategy for clinical T1N0 invasive lung cancer: A prospective, multicenter, clinical trial. J Thorac Oncol, 2023, 18(7): 931-939.
7.	吳漢然, 柳常青, 郭明發, 等. 系統性淋巴結清掃術和選擇性淋巴結清掃術治療早期食管癌的遠近期療效的對比研究. 中華外科雜志, 2018, 56(9): 706-711.Wu HR, Liu CQ, Guo MF, et al. A comparative study of the short-term efficacy and long-term efficacy of systematic lymph node dissection and elective lymph node dissection in patients with early eaophageal cancer. Chin J Surg, 2018, 56(9): 706-711.
8.	Kawamoto N, Tsutani Y, Kamigaichi A, et al. Tumour location predicts occult N1 nodal metastasis in clinical stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2023, 63(2): ezac575.
9.	Vecchiato M, Martino A, Sponza M, et al. Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position. Dis Esophagus, 2020, 33(12): doaa030.
10.	Buess G, Becker HD. Minimally invasive surgery in tumor of the esophagus. Langenbecks Arch Chir Suppl Ⅱ Verh Dtsch Ges Forsh Chir, 1990, 118: 1355‐1360.
11.	Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol, 2010, 16(30): 3804-3810.
12.	Song S, Shen C, Hu Y, et al. Application of inflatable video-assisted mediastinoscopic transhiatal esophagectomy in individualized treatment of esophageal cancer. Biomedicines, 2023, 11(10): 2750.
13.	Shi K, Qian R, Zhang X, et al. Video-assisted mediastinoscopic and laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc, 2022, 36(6): 4207-4214.
14.	Sasaki K, Tsuruda Y, Shimonosono M, et al. A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer. Surg Today, 2022, 52(12): 1759-1765.
15.	Chen Z, Huang K, Wei R, et al. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis. J Surg Oncol, 2022, 125(5): 839-846.
16.	Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
17.	Tokairin Y, Nakajima Y, Kawada K, et al. The usefulness of a bilateral trans-cervical pneumomediastinal approach for mediastinoscopic radical esophagectomy: a right transcervical approach is an available option. Gen Thorac Cardiovasc Surg, 2019, 67(10): 884-890.
18.	冷雪峰, 大幸宏幸, 韓泳濤. 食管鱗狀細胞癌NCCN指南及JES指南外科診療要點解讀. 腫瘤預防與治療, 2024, 37(4): 286-291.Leng XF, Daiko H, Han YT. Interpretation of NCCN and JES guidelines for diagnosis and treatment of esophageal squamous cell carcinoma. J Cancer Control Treat, 2024, 37(4): 286-291.
19.	程超, 肖鑫, 欒思源, 等. 食管癌淋巴結清掃范圍. 中華胃腸外科雜志, 2023, 26(4): 319-334.Cheng C, Xiao X, Luan SY, et al. Extent of lymphadenectomy for esophageal cancer. Chin J Gastrointest Surg, 2023, 26(4): 319-334.
20.	王雷, 劉彬, 陸運, 等. 胸段食管癌淋巴結清掃情況研究進展. 中國腫瘤外科雜志, 2020, 23(5): 489-492.Wang L, Liu B, Lu Y, et al. Study and application of lymph node dissection of thoracic esophageal cancer. Chin J Surg Oncol, 2020, 23(5): 489-492.
21.	Tokumaru S, Kitazawa M, Nakamura S, et al. Intraoperative visualization of morphological patterns of the thoracic duct by subcutaneous inguinal injection of indocyanine green in esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2022, 6(6): 873-879.
22.	Barbato G, Cammelli F, Braccini G, et al. Fluorescent lymphography for thoracic duct identification: Initial experience of a simplified and feasible ICG administration. Int J Med Robot, 2022, 18(3): e2380.
23.	Takhellambam L, Yadav TD, Kumar H, et al. Prophylactic ligation of the opacified thoracic duct in minimally invasive esophagectomy - Feasibility and safety. Langenbecks Arch Surg, 2021, 406(7): 2515-2520.
24.	Wang X, Hu Y, Wu X, et al. Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery. Surg Endosc, 2022, 36(6): 3994-4003.
25.	周瑜, 田東, 嚴高武, 等. 食管癌根治術常規清掃隆突下淋巴結的價值. 中華胸外外科電子雜志, 2017, 4(1): 7.Zhou Y, Tian D, Yan GW, et al. Value of routine subcarinal lymph node dissection in radical resection of esophageal cancer. Chin J Thorac Surg (Electronic Edition), 2017, 4(1): 7.
26.	Feng JF, Zzhao Q, Chen QX, et al. Prognositc value of subcarinal lymph node metastasis in patients with esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 2013, 14(5): 3138-3186.

1. 王培宇, 黃祺, 王少東, 等. 《全球癌癥統計數據2022》要點解讀. 中國胸心血管外科臨床雜志, 2024, 31(7): 933-954.Wang PY, Huang Q, Wang SJ, et al. Interpretation of the key points of global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Chin J Clin Thorac Cardiovasc Surg, 2024, 31(7): 933-954.
2. Igaue S, Fujita T, Oguma J, et al. Long-term survival in esophageal cancer: Comparison of minimally invasive and open esophagectomy. Ann Thorac Surg, 2025, 119(4): 805-814.
3. Tokairin Y, Nakajima Y, Kawada K, et al. A feasibility study of mediastinoscopic radical esophagectomy for thoracic esophageal cancer from the viewpoint of the dissected mediastinal lymph nodes validated with thoracoscopic procedure: A prospective clinical trial. Esophagus, 2019, 16(2): 214-219.
4. Liu C, Chen Z, Wei R, et al. Intra-operative events and countermeasures during esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy. J Thorac Dis, 2021, 13(1): 133-139.
5. 中華人民共和國國家衛生健康委員會醫政醫管局. 食管癌診療指南 (2022 年版). 中華消化外科雜志, 2022, 21(10): 1247-1268.Bureau of Medical Administration, National Health Commission of the People’s Republic of China. Standardization for diagnosis and treatment of esophageal cancer (2022 edition). Chin J Dig Surg, 2022, 21(10): 1247-1268.
6. Zhang Y, Deng C, Zheng Q, et al. Selective mediastinal lymph node dissection strategy for clinical T1N0 invasive lung cancer: A prospective, multicenter, clinical trial. J Thorac Oncol, 2023, 18(7): 931-939.
7. 吳漢然, 柳常青, 郭明發, 等. 系統性淋巴結清掃術和選擇性淋巴結清掃術治療早期食管癌的遠近期療效的對比研究. 中華外科雜志, 2018, 56(9): 706-711.Wu HR, Liu CQ, Guo MF, et al. A comparative study of the short-term efficacy and long-term efficacy of systematic lymph node dissection and elective lymph node dissection in patients with early eaophageal cancer. Chin J Surg, 2018, 56(9): 706-711.
8. Kawamoto N, Tsutani Y, Kamigaichi A, et al. Tumour location predicts occult N1 nodal metastasis in clinical stage Ⅰ non-small-cell lung cancer. Eur J Cardiothorac Surg, 2023, 63(2): ezac575.
9. Vecchiato M, Martino A, Sponza M, et al. Thoracic duct identification with indocyanine green fluorescence during minimally invasive esophagectomy with patient in prone position. Dis Esophagus, 2020, 33(12): doaa030.
10. Buess G, Becker HD. Minimally invasive surgery in tumor of the esophagus. Langenbecks Arch Chir Suppl Ⅱ Verh Dtsch Ges Forsh Chir, 1990, 118: 1355‐1360.
11. Barreto JC, Posner MC. Transhiatal versus transthoracic esophagectomy for esophageal cancer. World J Gastroenterol, 2010, 16(30): 3804-3810.
12. Song S, Shen C, Hu Y, et al. Application of inflatable video-assisted mediastinoscopic transhiatal esophagectomy in individualized treatment of esophageal cancer. Biomedicines, 2023, 11(10): 2750.
13. Shi K, Qian R, Zhang X, et al. Video-assisted mediastinoscopic and laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc, 2022, 36(6): 4207-4214.
14. Sasaki K, Tsuruda Y, Shimonosono M, et al. A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer. Surg Today, 2022, 52(12): 1759-1765.
15. Chen Z, Huang K, Wei R, et al. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis. J Surg Oncol, 2022, 125(5): 839-846.
16. Ajani JA, D'Amico TA, Bentrem DJ, et al. Esophageal and esophagogastric junction cancers, version 2. 2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2019, 17(7): 855-883.
17. Tokairin Y, Nakajima Y, Kawada K, et al. The usefulness of a bilateral trans-cervical pneumomediastinal approach for mediastinoscopic radical esophagectomy: a right transcervical approach is an available option. Gen Thorac Cardiovasc Surg, 2019, 67(10): 884-890.
18. 冷雪峰, 大幸宏幸, 韓泳濤. 食管鱗狀細胞癌NCCN指南及JES指南外科診療要點解讀. 腫瘤預防與治療, 2024, 37(4): 286-291.Leng XF, Daiko H, Han YT. Interpretation of NCCN and JES guidelines for diagnosis and treatment of esophageal squamous cell carcinoma. J Cancer Control Treat, 2024, 37(4): 286-291.
19. 程超, 肖鑫, 欒思源, 等. 食管癌淋巴結清掃范圍. 中華胃腸外科雜志, 2023, 26(4): 319-334.Cheng C, Xiao X, Luan SY, et al. Extent of lymphadenectomy for esophageal cancer. Chin J Gastrointest Surg, 2023, 26(4): 319-334.
20. 王雷, 劉彬, 陸運, 等. 胸段食管癌淋巴結清掃情況研究進展. 中國腫瘤外科雜志, 2020, 23(5): 489-492.Wang L, Liu B, Lu Y, et al. Study and application of lymph node dissection of thoracic esophageal cancer. Chin J Surg Oncol, 2020, 23(5): 489-492.
21. Tokumaru S, Kitazawa M, Nakamura S, et al. Intraoperative visualization of morphological patterns of the thoracic duct by subcutaneous inguinal injection of indocyanine green in esophagectomy for esophageal cancer. Ann Gastroenterol Surg, 2022, 6(6): 873-879.
22. Barbato G, Cammelli F, Braccini G, et al. Fluorescent lymphography for thoracic duct identification: Initial experience of a simplified and feasible ICG administration. Int J Med Robot, 2022, 18(3): e2380.
23. Takhellambam L, Yadav TD, Kumar H, et al. Prophylactic ligation of the opacified thoracic duct in minimally invasive esophagectomy - Feasibility and safety. Langenbecks Arch Surg, 2021, 406(7): 2515-2520.
24. Wang X, Hu Y, Wu X, et al. Near-infrared fluorescence imaging-guided lymphatic mapping in thoracic esophageal cancer surgery. Surg Endosc, 2022, 36(6): 3994-4003.
25. 周瑜, 田東, 嚴高武, 等. 食管癌根治術常規清掃隆突下淋巴結的價值. 中華胸外外科電子雜志, 2017, 4(1): 7.Zhou Y, Tian D, Yan GW, et al. Value of routine subcarinal lymph node dissection in radical resection of esophageal cancer. Chin J Thorac Surg (Electronic Edition), 2017, 4(1): 7.
26. Feng JF, Zzhao Q, Chen QX, et al. Prognositc value of subcarinal lymph node metastasis in patients with esophageal squamous cell carcinoma. Asian Pac J Cancer Prev, 2013, 14(5): 3138-3186.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesApplication of mediastinal lymph node dissection in inflatable video-assisted mediastinoscopic transhiatal esophagectomy

Abstract Full text Figures/Tables Video References Cited by

Format

Content