VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

Abstract

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.