Lymph node dissection around left recurrent laryngeal nerve: robot-assisted vs. video-assisted McKeown esophagectomy for
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and Other Interventional Techniques
Lymph node dissection around left recurrent laryngeal nerve: robot‑assisted vs. video‑assisted McKeown esophagectomy for esophageal squamous cell carcinoma Xiaofeng Duan1 · Jie Yue1 · Chuangui Chen1 · Lei Gong2 · Zhao Ma1 · Xiaobin Shang1 · Zhentao Yu2 · Hongjing Jiang1 Received: 21 March 2020 / Accepted: 16 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective This study investigated the advantages of robot-assisted McKeown esophagectomy (RAME) for extensive superior mediastinal lymph node dissection (LND) versus video-assisted McKeown esophagectomy (VAME). Methods The cases of 184 consecutive esophageal squamous cell carcinoma (ESCC) patients who underwent minimally invasive McKeown esophagectomy (109 with RAME, 75 with VAME) performed by a single surgical group between June 2017 and December 2019 were retrospectively reviewed. Results Overall, 59.8% (110/181) patients (70 treated with RAME, 40 treated with VAME; 64.2% vs. 53.3%, respectively, p = 0.139) underwent complete LND around the left recurrent laryngeal nerve (RLN) by pathological assessment. Cumulative sum plots showed increased numbers of LND around the left RLN (3.6 ± 2.0 vs. 5.4 ± 2.7, p = 0.008) and a decreased incidence of recurrent nerve injury (27.9% vs. 7.4%, p = 0.037) after RAME learning curve. Despite similar overall LND results (30.6 ± 10.2 vs. 28.1 ± 10.2, p > 0.05), RAME yielded more LND (5.4 ± 2.7 vs. 4.4 ± 2.2, p = 0.016) and a greater proportion of lymph node metastases (37.0% vs. 7.5%) around the left RLN but induced a lower proportion of recurrent nerve injuries (7.4% vs. 22.5%, p = 0.178) compared with VAME. Further analysis revealed that the complete LND around the left RLN was associated with recurrent nerve injury in the RAME (20.0% vs. 5.1%, p = 0.035) and VAME (22.5% vs. 5.7%, p = 0.041) groups but did not affect other clinical outcomes including surgical duration, intraoperative blood loss, postoperative intensive care unit stay, hospital stay, and other complications. Conclusions For patients with ESCC, RAME has great advantages in LND around the left RLN and recurrent nerve protection after learning curve of robotic esophagectomy. Keywords Esophageal squamous cell carcinoma · Lymph node dissection · Minimally invasive esophagectomy · Recurrent laryngeal nerve · Robot surgery Despite high postoperative complication and mortality rates after esophagectomy, radical surgical resection remains the mainstream treatment method for early esophageal * Hongjing Jiang [email protected] 1
Department of Minimally Invasive Esophageal Surgery, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Hospital and Institute, Tiyuanbei, Huanhuxi Rd., Hexi District, Tianjin 300060, China
Department of Esophageal Cancer, Tianjin Medical University Cancer Hospital and Institute, Tianjin 300060, China
2
cancer and those after induction therapy. Minimally invasive esophagecto
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