Oncologic outcomes of thoracoscopic esophagectomy with extended lymph node dissection: 10-year experience from a single center.

Background: The oncologic feasibility of video-assisted thoracoscopic (VATS) radical esophagectomy for esophageal cancer has yet to be proven. We evaluated the oncologic outcome of VATS-esophagectomy by reviewing our 10-year experience, with particular emphasis on the effect of lymph node dissection.

Methods: From January 2003 to December 2012, 146 patients with esophageal cancer underwent completion of VATS-esophagectomy in the left lateral position.

Results: The mean follow-up period was 37.1 months. Forty-six patients (31.5 %) had recurrence of cancer. Primary recurrence was hematogenous, lymphatic, peritoneal dissemination, pleural dissemination, locoregional, or port site in 20 (13.7 %), 23 (15.8 %), 2 (1.4 %), 5 (3.4 %), 4 (2.7 %), and 1 (0.67 %) patients, respectively. Pleural dissemination occurred more frequently after noncurative operation than curative operation (p = 0.010). The frequency of lymphatic metastasis within the mediastinal regional lymph nodes in the dissection field was only 5.5 %. The overall 5-year survival rate of stage I, II, and III disease after curative VATS-esophagectomy was 79.1, 77.9, and 56.7 %, respectively. T4 tumor, lymph node metastasis, R1 or 2, and concomitant lymph node metastasis in the cervical, mediastinal, and abdominal fields were indicators of unfavorable outcome. The lymph nodes in the abdominal region and those around the bilateral recurrent laryngeal nerves (RLNs) were frequent metastasis sites. Patients who had metastasis only around RLNs had favorable survival comparable to node-negative cases after curative VATS-esophagectomy.

Conclusions: Video-assisted thorascopic-esophagectomy has an excellent locoregional control effect with favorable oncologic outcome. The lymph node dissection procedure by VATS-esophagectomy has survival benefit for the patients having lymph node metastasis around bilateral RLNs.