Upper mediastinal lymph node dissection based on mesenteric excision in esophageal cancer surgery: confirmation by near-
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ORIGINAL ARTICLE
Upper mediastinal lymph node dissection based on mesenteric excision in esophageal cancer surgery: confirmation by near‑infrared image‑guided lymphatic mapping and the impact on locoregional control Hisahiro Hosogi1 · Daisuke Yagi1 · Masazumi Sakaguchi1 · Shin Akagawa1,2 · Yukinari Tokoro1 · Seiichiro Kanaya1 Received: 3 August 2020 / Accepted: 7 October 2020 © The Japan Esophageal Society 2020
Abstract Background We previously reported a novel method of mesenteric excision for esophageal cancer surgery. The esophagus, trachea, recurrent laryngeal nerves (RLNs), and surrounding lymph nodes (LNs) are contained in a common mesenterium, which we termed the “mesotracheoesophagus”. In addition, near-infrared (NIR) image-guided lymphatic mapping has recently been used. The purpose of this study was to confirm the feasibility of NIR image-guided lymphatic mapping for upper mediastinal LN dissection, and to confirm the oncological feasibility of our surgical approach. Methods Fifteen patients with resectable esophageal cancer underwent submucosal injection of indocyanine green (ICG), and underwent robot-assisted esophagectomy. The frequency of ICG positivity in the LN basins along the RLNs, and metastatic frequency were assessed. Regarding the oncological feasibility of our thoracoscopic esophagectomy, the recurrence patterns and survival of 72 consecutive patients who underwent curative resection from 2011 to 2016 were analyzed. Results ICG-positive LN basins along the right and left RLNs were found in 12 (80% of 15) patients (3 patients positive for metastatic LNs) and 11 (73% of 15) patients (2 positive for metastatic LNs and 1 false-negative), respectively. All ICGpositive LN basins were found within the mesotracheoesophagus. The sensitivity was 5/6 (83%), and the negative predictive value was 6/7 (86%). Among the 72 patients, with a median follow-up period of 1644 days, only 3 (4.2%) patients developed locoregional recurrence. Conclusions The NIR image-guided lymphatic mapping was feasible. Our results with no ICG-positive basins outside of the ‘”mesotracheoesophagus”, supported our surgical approach. It might become standard, with acceptable locoregional control. Keywords Mesenteric excision · Esophageal cancer · Lymphatic mapping · Recurrence
Introduction
Hisahiro Hosogi and Daisuke Yagi have contributed equally to the work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10388-020-00789-8) contains supplementary material, which is available to authorized users. * Hisahiro Hosogi [email protected]‑u.ac.jp 1
Department of Surgery, Japanese Red Cross Osaka Hospital, 5‑30 Fudegasakicho, Tennoji Ward, Osaka 543‑8555, Japan
Department of Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
2
The lymph nodes (LNs) along the recurrent laryngeal nerves (RLNs) are among the most frequently involved LNs in esophageal cancer, especially in squamous-cell carcinoma (SCC), and dissection of these LNs has been regarded as a key st
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