Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2016; 22(19): 4750-4756
Published online May 21, 2016. doi: 10.3748/wjg.v22.i19.4750
Lymph node dissection in esophageal carcinoma: Minimally invasive esophagectomy vs open surgery
Bo Ye, Chen-Xi Zhong, Yu Yang, Wen-Tao Fang, Teng Mao, Chun-Yu Ji, Zhi-Gang Li
Bo Ye, Chen-Xi Zhong, Yu Yang, Wen-Tao Fang, Teng Mao, Chun-Yu Ji, Zhi-Gang Li, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Author contributions: All authors equally contributed to this paper.
Supported by the National Natural Science Foundation of China, No. 81372472
Institutional review board statement: The study was conducted in accordance with the principles of the Declaration of Helsinki, and the ethics committee of Shanghai Chest Hospital, Shanghai Jiaotong University, approved the study protocol.
Informed consent statement: All patients provided written informed consent for surgery. Because of the retrospective nature of the study, the requirement for patient consent for inclusion in the present study was waived.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: There is no additional data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Zhi-Gang Li, MD, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihaixi Road, Shanghai 200030, China. dr_lizhigang@163.com
Telephone: +86-21-22200000-2231
Received: November 11, 2015
Peer-review started: November 12, 2015
First decision: February 28, 2016
Revised: February 25, 2016
Accepted: March 14, 2016
Article in press: March 14, 2016
Published online: May 21, 2016
Processing time: 126 Days and 14 Hours
Abstract

AIM: To compare lymph node dissection results of minimally invasive esophagectomy (MIE) and open surgery for esophageal squamous cell carcinoma.

METHODS: We retrospectively reviewed data from patients who underwent MIE or open surgery for esophageal squamous cell carcinoma from January 2011 to September 2014. Number of lymph nodes resected, positive lymph node (pN+) rate, lymph node sampling (LNS) rate and lymph node metastatic (LNM) rate were evaluated.

RESULTS: Among 447 patients included, 123 underwent MIE and 324 underwent open surgery. The number of lymph nodes resected did not significantly differ between the MIE and open surgery groups (21.1 ± 4.3 vs 20.4 ± 3.8, respectively, P = 0.0944). The pN+ rate of stage T3 esophageal squamous cell carcinoma in the open surgery group was higher than that in the MIE group (16.3% vs 11.4%, P = 0.031), but no differences was observed for stages T1 and T2 esophageal squamous cell carcinoma. The LNS rate at left para-recurrent laryngeal nerve (RLN) site was significantly higher for open surgery than for MIE (80.2% vs 43.9%, P < 0.001), but no differences were noted at other sites. The LNM rate at left para-RLN site in the open surgery group was significantly higher than that in the MIE group, regardless of pathologic T stage.

CONCLUSION: For stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection result after MIE was comparable to that achieved by open surgery. However, the efficacy of MIE in lymphadenectomy for stage T3 esophageal squamous cell carcinoma, particularly at left para-RLN site, remains to be improved.

Keywords: Esophageal cancer; Lymph node; Minimally invasive; Surgery

Core tip: Previous studies have not reported in detail whether minimally invasive esophagectomy (MIE) can achieve the same lymph node dissection results as open surgery. In particular for esophageal squamous cell carcinoma, it remains unknown whether MIE can meet the technical requirements for each anatomical site in lymph node dissection from the mediastinum to the upper abdomen. Our study found that for stages T1 and T2 esophageal squamous cell carcinoma, the lymph node dissection result after MIE was comparable with that after open surgery. However, the efficacy of MIE in lymphadenectomy for stage T3 esophageal squamous cell carcinoma, particularly at left para-RLN site, remains to be improved.