The application of the anatomical meso-esophageal dissection in the left recurrent laryngeal nerve chain lymph node dissection during thoracoscopic esophagectomy
Objective:To compare the efficacy,complications,and healing between the anatomical meso-esophageal dissection and traditional methods in thoracoscopic esophageal cancer surgery for left recurrent laryngeal nerve lymph node dissection. Methods:A total of 168 patients who underwent thoracoscopic combined minimally invasive esophagectomy(McKeown procedure)in our hospital for esophageal cancer from January 2017 to June 2018 were collected. Among them,the anatomical membrane method was performed in 100 cases for left recurrent laryngeal nerve lymph node dissection,while traditional surgical method was used in 68 cases. The surgical data and perioperative complications of the two lymph node dissection methods were compared. Cox regression analysis was used to determine whether the left recurrent laryngeal nerve lymph node dissection method was an independent risk factor affecting disease-free survival(DFS)in esophageal cancer patients. Results:There were no significant difference in surgical time[(191.5±19.6) min vs.(197.2±16.7)min],average length of hospital stay[(12.5±2.4)d vs.(12.1±2.1)d],intraoperative blood loss[(138.8±52.4)mL vs.(132.7±43.3)mL],etc. between the two groups. The number of resected left recurrent laryngeal nerve lymph nodes dissected in the modified group was significantly high[(2.93±1.19)vs.(2.57±0.98),P=0.036],while the proportion of recurrent laryngeal nerveinjury was significantly low(2% vs. 13%,P=0.010),compared with traditional group. Multivariate Cox regression analysis suggested that the method of the dissection of recurrent laryngeal nerve lymph node,TMN stage,and tumor differentiation were independent risk factors for esophageal cancer recurrence(P=0.012,0.037,0.045). Conclusion:The use of the anatomical membrane method to dissect the left recurrent laryngeal nerve lymph nodes can significantly reduce postoperative complications of esophageal cancer,effectively improve disease-free survival(DFS)after surgery,and has great application value in the dissection of the left recurrent laryngeal nerve lymph nodes.