| Objective: To systematically study and summarize the experience of lymph node dissection of the recurrent laryngeal nerve chain during Mckeown’s esophageal cancer surgery and to explore the best surgical approach and dissection mode.Materials and methods: A retrospective analysis of 297 patients with ESCC who underwent a radical Mckeown esophageal cancer operation from January 2015 to April2019 in Tongji Hospital affiliated to Huazhong University of Science and Technology was included in 244 cases finally.Clinical datas of all patients were collected,including geneal clinical data,the conditions of thoracic lymph node dissection and metastasis,postoperative conditions,postoperative complications(especially recurrent laryngeal nerve injury),and follow-up of all patients.The patients were divided into thoracoscopy group and thoracotomy group(147 V.S 97)according to the surgical methods;the thoracoscopy group was divided into two-hole group and four-hole group(107 V.S 40)according to the number of incisions,then according to different anesthesia intubation methods,two-hole group was divided into double-lumen tube group and stuffed tube group(114 V.S 32).The general clinical data,the conditions of lymph node dissection and metastasis(especially recurrent laryngeal nerve chain lymph node),perioperative results and postoperative complications(especially recurrent laryngeal nerve injury)in the first three groups of patients were analysised to explore which surgical methods have advantages in RLNLN dissection under different surgical methods;Last,according to different intraoperative RLNLN dissection methods,the two-hole group was further divided into a complete dissection group and a conventional dissection group(75 V.S 32).we compare and analyze the number of lymph node dissections and recurrent laryngeal nerve injury in the group of patients,and explore which method is more effective.According to the postoperative follow-up results,Logistic univariate regression analysis(UA)was used to analyze the prognostic factors that affect the overall survival rate of patients,Cox multivariate regression analysis(MA)was used to analyze the independent prognostic factors that affected the overall survival rate of patients,We used Kaplan-Meier method for survival analysis,and applied Log-rank test to compare the differences in survival curves,and to analyze the relationship between the number of lymph node dissections,the degree of metastasis,and the degree of recurrent laryngeal nerve injury in patients with OS.Results:(1)General clinical datas: thoracoscopic group and thoracotomy group,two-portal group and four-portal group,double-lumen tube group and stuffing tube group in age,gender,tumor location,preoperative combined disease,tumor pathology,T stage,N stage,and tumor differentiation were no significant differences(P> 0.05).(2)Intraoperative lymph node dissection: There were no significant differences in the lymph node dissection between the two-portal group and the four-portal group,and there was a significant difference in the total number of lymph node dissections between the thoracotomy group and the thoracoscopy group(15.51±6.7 VS 19.69±8.7,P <0.05);there were significant differences in the total number of RLNLN between the double-lumen tube group and the stuffing tube group(4.62±3.5 VS 6.50±4.4,P <0.05).(3)The success rate of postoperative lymph node dissection: There were no significant differences between the two-portal group and the four-portal group,and the successful rate of lymph node dissection in the left recurrent laryngeal nerve chain between the thoracoscopy group and thoracotomy group was a significant difference(64.6% VS 92.7%,P <0.05);there was a significant difference in the right recurrent laryngeal nerve chain between the double-lumen tube group and the stuffed tube group(78.9% VS 96.8%,P<0.05).(4)Postoperative results and complications: Operation time and intraoperative blood loss in the chest,postoperative hospital stay and in the incidence of postoperative pulmonary related complications and perioperative mortality,there was no significant difference.However,the incidence of postoperative hoarseness in the thoracoscopic group and the thoracotomy group(21.1% VS 30.9%,P <0.05),the number of postoperative suctions(3.69±1.7 VS 5.42±3.6,P <0.05)and the incidence of postoperative complications(37.4%VS 52.5%,P <0.05)were significant differences;the double-lumen tube group and the stuffing tube were significant differences in the rate of RLNP(24.5% VS 12.5%,P <0.05)and the number of postoperative suctions(3.67±1.7 VS 2.11±1.5,P <0.05).(5)Comparison of different RLNLN dissection methods: the total number of lymph node dissections in the recurrent laryngeal nerve chain between the complete dissection group and the conventional dissection group(5.22±3.7 VS 3.01±2.7,P <0.05)and the number of lymph node dissections in the left recurrent laryngeal nerve chain(2.48±2.8 VS 0.90±1.3,P<0.01)were significant differences,but there was no significant difference in the rate of recurrent laryngeal nerve injury between the two groups.(6)Prognostic factors: The use of logistic univariate regression analysis revealed that the tumor pathology T stage,N stage,tumor location,RLNLN metastasis,and the degree of RLNLN metastasis affect the patient’s OS,and the degree of recurrent laryngeal nerve injury will not affect the patient’s OS;then Cox multivariate regression analysis was used to find tumor pathology T stage,N stage,the degree of RLNLN metastasis,and whether RLN metastasis was independent prognostic factors affecting OS in patients.(7)The relationship between the number of lymph node dissections,metastasis,and recurrent laryngeal nerve injury with patinet’s OS: Kaplan-Meier method was used for survival analysis,and the differences in survival curves were compared by log-rank test that found the number of lymph node dissections of RLN and degrees of recurrent laryngeal nerve injury have no significant effect on the patient’s OS.However,the degree of lymph node metastasis of the RLN have significant differences in OS.The greater the degree of metastasis,the worse the prognosis.Conclusion:(1)Whether the surgical method is minimally invasive,compared with open esophageal cancer radical surgery,thoracoscopic esophageal cancer radical surgery has less surgical trauma,fewer postoperative complications,faster postoperative recovery,and more thorough chest lymph node dissection.It should be the first choice for esophageal cancer.(2)In the selection of surgical minimally invasive incisions,the two-portal group and the four-portal group had no significant differences in lymph node dissection,postoperative complications,and postoperative recovery,and the advantages were comparable.(3)In terms of surgical anesthesia intubation,compared with the double-lumen tube group,RLNLN dissection is better in the packed tube group,and the recurrent laryngeal nerve injury rate is lower after surgery,which is worthy of widespread popularization and application.(4)In the choice of RLNLN dissection method,the complete dissection group is significantly better than the conventional dissection group,with more effective recurrent laryngeal nerve chain node dissection,and the recurrent laryngeal nerve injury rate has not increased significantly.(5)T-stage,N-stage,tumor location,RLNLN metastasis,and degree of RLNLN metastasis are prognostic factors;T-stage,N stage,and the degree of RLNLN metastasis and RLNLN metastasis are independent prognostic factors.The number of lymph node resections and the degree of recurrent laryngeal nerve injury have no significant effect on the patient’s OS.However,the degree of RLNLN metastasis are significant differences in the OS of patients.The greater the degree of metastasis,the worse the prognosis. |
PDF Full Text Request