Preoperative Diagnosis And Resection Of Recurrent Laryngeal Nerve Node In Thoracic Esophageal Squamous Cell Carcinoma

Objective:In order to evaluate the safety and necessity of recurrent laryngeal nerve lymph node resection,this study compared the complications and prognosis of recurrent laryngeal nerve injury in patients with different methods of recurrent laryngeal lymph nerve node resection.Methods:We reviewed 153 patients with stage T1N0M0 esophageal squamous cell carcinoma who underwent radical esophageal cancer surgery at the Department of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from June 2014 to May 2016.Among them,125 were male and 28 were female.Age 62.All patients underwent at least left and right recurrent laryngeal nerve lymph nodes.Patients with only one recurrent laryngeal nerve lymph node resection on both sides during the operation were taken as the sampling group;patients with only one recurrent laryngeal nerve lymph node resection on one side and more than one recurrent laryngeal nerve lymph nodes resection on the other side were used as unilateral dissection groups;patients with more than one recurrent laryngeal nerve lymph nodes resection on both sides were included as a bilateral dissection group.Follow-up was performed to compare the prognostic differences between patients in each group.Seven days after the operation,the vocal cords of the patients were examined with an electronic laryngoscope and classified using the Clavien-Dindo(CD)system.The differences in complications related to recurrent laryngeal nerve injury between the groups were compared.Results:Among T1N0M0 patients,the 5-year OS rate of patients in the sampling group was 66.8%;the 5-year OS rate of patients in the unilateral dissection group was88.5%;and the 5-year OS rate of patients in the bilateral dissection group was 93.8%.The 5-year OS rate was statistically different between patients in the sampling group and those in the unilateral dissection group or the bilateral dissection group(P <0.05),and the 5-year OS rate was no statistical different between the patients in the unilateral dissection group and the patients in the bilateral dissection group(P> 0.05).There was no statistical difference in the occurrence of complications between patients in each group(P> 0.05).Conclusion:For patients with esophageal squamous cell carcinoma of stage T1N0M0,the lymph nodes of the left and right recurrent laryngeal nerves should be removed during the operation as much as possible,which will help improve the 5-year survival rate of the patients.Objective:The preoperative diagnostic criteria for recurrent laryngeal nerve lymph node metastasis in thoracic esophageal squamous cell carcinoma were obtained by measuring the size of the recurrent laryngeal nerve lymph nodes in patients with thoracic esophageal squamous cell carcinoma.Methods:A total of 448 patients with thoracic esophageal squamous cell carcinoma who underwent thoracic laparoscopy combined with three-incision esophageal cancer radical surgery in the Department of Thoracic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2017 to December 2019 were observed.There were 387 males and 61 females,with an average age of 60.3 ± 5.8 years.All patients did not undergo radiotherapy and chemotherapy before surgery.The patient underwent chest enhancement CT scan in the radiology department of Tongji Hospital within one week before the operation,and read the CT image to measure the maximum long diameter and maximum short diameter of the recurrent laryngeal lymph nodes obtained by the patient.Compare the relationship between postoperative pathological results of lymph nodes and preoperative CT measurement indexes.Results: A total of 2358 recurrent laryngeal nerve lymph nodes were obtained from the left and right recurrent laryngeal nerves,of which 63 were positive and 2295 were negative.The CT images showed that the average maximum diameter of the positive lymph nodes was 12.7 mm,and the average maximum diameter of the negative lymph nodes was 7.6 mm,p <0.001.The average maximum short diameter of the positive lymph nodes was 7.7mm,and the average maximum short diameter of the negative lymph nodes was 4.9mm,p = 0.004.ROC curve analysis showed that the maximum length of the lymph nodes ≥9.2mm can be used as a preoperative diagnostic standard for recurrent laryngeal nerve lymph node metastasis of thoracic esophageal squamous cell carcinoma.The sensitivity is 96.2%,the specificity is 76.5%,and the diagnostic accuracy rate is 83.0%.The area under the curve(AUC)is0.886 with high accuracy.Youden index is 0.727,the diagnosis is more authentic.The maximum short diameter of the lymph nodes ≥5.7mm can be used as a preoperative diagnostic standard for thoracic esophageal squamous cell carcinoma with recurrent laryngeal nerve lymph node metastasis.The sensitivity is 84.6%,the specificity is75.0%,the diagnostic accuracy is 78.7%,and the area under the curve(AUC)The accuracy is 0.848.Youden index is 0.596,the diagnosis is more authentic.Conclusion:The maximum long diameter of the intrathoracic lymph nodes on the CT image ≥9.2mm,the maximum short diameter ≥5.7mm can be used as the preoperative reference standard for recurrent laryngeal nerve lymph node metastasis of esophageal squamous cell carcinoma.