Approaches to resection of recurrent solitary mediastinal lymph nodes after esophagectomy
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Approaches to resection of recurrent solitary mediastinal lymph nodes after esophagectomy Satoru Motoyama1,2,3 · Yusuke Sato1,3 · Akiyuki Wakita1,3 · Yushi Nagaki1,3 · Hiromu Fujita1,3 · Kazuhiro Imai3 · Yoshihiro Minamiya3 Received: 28 September 2020 / Accepted: 6 November 2020 © The Japan Esophageal Society 2020
Abstract Esophageal cancer recurrence in solitary mediastinal lymph node that may possibly been left behind in the first surgery differs from other recurrence patterns because it is still local disease and offers the possibility of complete cure through resection, but it is technically difficult. We resected recurrent mediastinal lymph nodes in six cases. A left transthoracic approach was used in three patients. Other approaches were left thoracoabdominal, right open transthoracic and transcervical. R0 resections were achieved in five patients without severe surgical stress or postoperative complications. Overall survival after resection of recurrent lymph nodes was 43 (16–82) months. Approaches to resection of recurrent solitary mediastinal lymph nodes after esophagectomy should be consider to perform curative treatment safely and less invasively. Keywords Esophagectomy · Recurrence · Mediastinal lymph node · Resection · Approach
Introduction The incidence of death due to recurrent thoracic esophageal cancer after curative esophagectomy with extensive lymph node (LN) dissection is about 30–40%, even with the multimodal treatments widely used today [1–3]. For that reason, development of a treatment for recurrent esophageal cancer continues to be a main focus for us. Although thoracic esophageal cancer frequently recurs in distant organs and/or LNs, recurrence in a regional mediastinal LN that may possibly been left behind in the first surgery differs from other recurrence patterns. It is still local disease and the possibility of complete cure with local treatment remains. However, such LNs are technically difficult to remove. So how do you treat this type of recurrence? Usually, chemo-radiotherapy has been the treatment of choice because of the technical difficulty of resection of a mediastinal LN after esophagectomy * Satoru Motoyama [email protected]‑u.ac.jp 1
Esophageal Surgery, Akita University Hospital, 1‑1‑1 Hondo, Akita 010‑8543, Japan
2
Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan
3
Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
and the amount of surgical stress and damage a second surgery could cause these patients [2, 4]. On the other hand, our strategy for treating recurrence in a solitary mediastinal LN is to apply surgical resection whenever possible by devising an appropriate resection approach to a complete cure.
Approaches to resection Between 2010 and 2019, 423 consecutive patients underwent esophagectomy with 2- or 3-field lymphadenectomy for thoracic esophageal cancer at Akita University Hospital. The histology of the tumors was mainly squamous cell carcinoma (92%). Among th
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