[Clinical value of thoracoscopic extensive mediastinal lymphadenectomy in the surgical treatment of esophageal carcinoma].

OBJECTIVE: To explore the safety and feasibility of extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy in the treatment of esophageal carcinoma.

METHODS: Clinical data of 125 patients with esophageal carcinoma undergoing thoracoscopic and laparoscopic esophagectomy(TLE) in West China Hospital of Sichuan University between May 2009 and December 2011 were retrospectively analyzed. Patients were divided into 2 groups: non-extensive mediastinal lymphadenectomy group(non-extensive group, n=53) and extensive mediastinal lymphadenectomy group(extensive group, n=72). Perioperative outcomes of these two groups were compared.

RESULTS: No significant differences were found in the time of thoracic operation, length of intensive care unit stay and postoperative hospital stay, postoperative complication and the overall mortality between the two groups. Compared with non-extensive group, extensive group showed less blood loss during thoracic operation [(140.6±62.1) ml vs. (167.7±69.2) ml, P=0.023], more thoracic lymph nodes harvested (12.2±4.2 vs. 9.0±4.1, P<0.01). Seventeen patients (23.6%) in extensive group were found to have positive recurrent laryngeal nerve lymph nodes, which resulted in upstaging of TNM in 7 patients(9.7%). The incidence of recurrent laryngeal nerve palsy was higher in extensive group as compared to non-extensive group, but the difference was not statistically significant (6.9% vs. 1.9%, P=0.240).

CONCLUSION: Extensive mediastinal lymphadenectomy during thoracoscopic esophagectomy is a feasible and safe procedure for esophageal carcinoma patients, which can increase the number of harvested lymph node and the accuracy of tumor staging.