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Upper mediastinal lymph node dissection based on mesenteric excision in esophageal cancer surgery: confirmation by near-infrared image-guided lymphatic mapping and the impact on locoregional control. | LitMetric

AI Article Synopsis

  • - The study explores a new surgical technique for esophageal cancer involving mesenteric excision and the use of near-infrared (NIR) imaging to map lymphatic drainage in the "mesotracheoesophagus".
  • - Fifteen patients with operable esophageal cancer underwent a procedure where indocyanine green (ICG) was injected to visualize lymph nodes; results showed a high detection rate of positive lymph nodes, revealing potential metastatic spread.
  • - The analysis of 72 patients who underwent similar surgeries from 2011 to 2016 indicated a low recurrence rate and supported the use of NIR imaging for effective lymph node dissection, suggesting it could standardize surgical practice.

Article Abstract

Background: We previously reported a novel method of mesenteric excision for esophageal cancer surgery. The esophagus, trachea, recurrent laryngeal nerves (RLNs), and surrounding lymph nodes (LNs) are contained in a common mesenterium, which we termed the "mesotracheoesophagus". In addition, near-infrared (NIR) image-guided lymphatic mapping has recently been used. The purpose of this study was to confirm the feasibility of NIR image-guided lymphatic mapping for upper mediastinal LN dissection, and to confirm the oncological feasibility of our surgical approach.

Methods: Fifteen patients with resectable esophageal cancer underwent submucosal injection of indocyanine green (ICG), and underwent robot-assisted esophagectomy. The frequency of ICG positivity in the LN basins along the RLNs, and metastatic frequency were assessed. Regarding the oncological feasibility of our thoracoscopic esophagectomy, the recurrence patterns and survival of 72 consecutive patients who underwent curative resection from 2011 to 2016 were analyzed.

Results: ICG-positive LN basins along the right and left RLNs were found in 12 (80% of 15) patients (3 patients positive for metastatic LNs) and 11 (73% of 15) patients (2 positive for metastatic LNs and 1 false-negative), respectively. All ICG-positive LN basins were found within the mesotracheoesophagus. The sensitivity was 5/6 (83%), and the negative predictive value was 6/7 (86%). Among the 72 patients, with a median follow-up period of 1644 days, only 3 (4.2%) patients developed locoregional recurrence.

Conclusions: The NIR image-guided lymphatic mapping was feasible. Our results with no ICG-positive basins outside of the '"mesotracheoesophagus", supported our surgical approach. It might become standard, with acceptable locoregional control.

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Source
http://dx.doi.org/10.1007/s10388-020-00789-8DOI Listing

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