431. DISSECTION OF THE SUPRACARINAL MESOESOPHAGUS RECURRENTIAL LYMPHADENECTOMY AND RECURRENT NERVE DAMAGE

IF 2.3 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY
Pablo Guerrero, Fernando Mingol Navarro, Marcos Bruna Esteban, David Quevedo Cruz, Marta Nieto, Carmen Gutiérrez Sánchez, Cristina Martínez Chicote, Francisco Javier Vaqué Urbaneja
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引用次数: 0

Abstract

Background Currently, an extended mediastinal lymphadenectomy is considered paramount for an accurate cancer staging as well as to improve the oncologic outcomes of patients with locally advanced esophageal cancer. Following the recently described supracarinal mesoesophagus (Cuesta et. al. 2023) allows a complete lymphadenectomy, including the left recurrential area. However, this dissection represents a considerable challenge and could be associated with significant complications. The aim of this study is to analyse if the extended lymphadenectomy guided by the anatomy of the superior mesoesophagus enables a more careful dissection of the recurrent nerves in order to avoid an injury of these structures. Methods We prospectively studied all patients in our centre with advanced esophageal cancer, from 2018 to 2023, who underwent esophagectomy and recurrent lymphadenectomy following the surgical plane of the supracarinal mesoesophagus (both unilateral and bilateral). All procedures were performed as curative intent by the same surgeon. We analysed all patients with recurrent nerve lesions and their severity, as well as their implication through the postoperative period and the treatment needed for their repair. In addition, we also studied the number of adenopathies included in the specimen, specifying those that belonged to the recurrential area and its positivity for tumoral cells. Results We included 40 patients in our study, 30 men and 10 women with an average age of 65 years. All of them received neoadyuvant therapy previous to the surgery (mostly CROSS and FLOT schemes). There were only 2 patients (5%) who suffered from permanent recurrent palsy, both needing surgical treatment for its correction. Two other patients had mild dysphonia that could be resolved with phoniatric rehabilitation. No fatal outcome occurred secondary to recurrent nerve injury. The median number of adenopathies resected in total was 35, while the median number of adenopathies corresponding to the recurrential area was 5. Conclusions In this study we have observed that, following the landmarks of the supracarinal mesoesophagus allows us to perform an extended mediastinal lymphadenectomy reducing the recurrent nerves injury down to only 5%. Even though a lesion of the recurrent nerves could imply a major influence on the quality of life, performing this dissection meticulously could improve the quality of cancer staging, overall and disease-free survival without significantly increasing the risk of recurrent nerve damage. For this reason, the proper knowledge of these anatomical planes of dissection may help improve lymphadenectomies without increasing or even reducing the rate of recurrent nerve injury.
431.食管上嵴中段复发性淋巴结切除术和复发性神经损伤切除术
背景 目前,扩大纵隔淋巴结切除术被认为是准确进行癌症分期以及改善局部晚期食管癌患者肿瘤治疗效果的关键。按照最近描述的食管上中段(Cuesta 等人,2023 年),可以进行完整的淋巴腺切除,包括左侧复发区域。然而,这种切除术是一项相当大的挑战,可能会引起严重的并发症。本研究的目的是分析在食管上中段解剖学指导下的扩大淋巴腺切除术是否能更仔细地解剖复流神经,以避免损伤这些结构。方法 我们对本中心 2018 年至 2023 年期间所有晚期食管癌患者进行了前瞻性研究,这些患者在食管上中膜手术平面(单侧和双侧)后接受了食管切除术和复发淋巴结切除术。所有手术均由同一名外科医生进行。我们分析了所有有复发性神经损伤的患者及其严重程度,以及术后的影响和修复所需的治疗。此外,我们还研究了标本中腺瘤的数量,明确了属于复发区域的腺瘤及其肿瘤细胞的阳性率。结果 我们研究了 40 名患者,其中男性 30 人,女性 10 人,平均年龄 65 岁。所有患者在手术前都接受了新辅助治疗(主要是 CROSS 和 FLOT 方案)。只有两名患者(5%)患有永久性复发性麻痹,都需要手术治疗来矫正。另外两名患者有轻微的发音障碍,通过语音康复治疗可以解决。没有人因复发性神经损伤而死亡。切除的腺样体总数中位数为 35 个,而复发区域腺样体的中位数为 5 个。 结论 在这项研究中,我们观察到,根据食管上中段的地标,我们可以进行纵隔淋巴结扩大切除术,将复发神经损伤率降低到仅 5%。尽管返流神经的病变可能会对患者的生活质量产生重大影响,但在不显著增加返流神经损伤风险的情况下,细致地进行这种切除术可以提高癌症分期、总生存率和无病生存率的质量。因此,正确认识这些解剖解剖平面有助于改善淋巴腺切除术,而不会增加甚至降低复发性神经损伤的发生率。
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来源期刊
Diseases of the Esophagus
Diseases of the Esophagus 医学-胃肠肝病学
CiteScore
5.30
自引率
7.70%
发文量
568
审稿时长
6 months
期刊介绍: Diseases of the Esophagus covers all aspects of the esophagus - etiology, investigation and diagnosis, and both medical and surgical treatment.
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