OBJECTIVETo explore the feasibility and safety of radical mediastinal lymphadenectomy in thoracoscopic esophagectomy for esophageal cancer.

METHODSWe retrospectively analyzed the clinical data of a cohort of 147 patients with esophageal cancer who underwent thoracoscopic esophagectomy. Seventy-one patients received traditional lymphadenectomy for the periesophageal and subcarinal lymph nodes (traditional dissection group), while 76 patients received radical lymph node dissection for the bilateral recurrent laryngeal nerve lymphatic chains as well as the periesophageal and subcarinal nodes (radical dissection group). The number of retrieved lymph nodes, incidence of node metastasis, the operation time, estimated blood loss, complications, morbidity and mortality were compared between the two groups.

RESULTSThoracoscopic esophagectomy was completed in all patients with no conversion to thoracotomy. There were no significant differences of operational time and blood loss between the two groups [(89 ± 32) min versus (99 ± 32) min, P = 0.064; (152 ± 108) ml versus (107 ± 82) ml, P = 0.261]. In all patients, the total and average number of retrieved mediastinal nodes were 1644 and 11.2 ± 5.9/case, and the incidence of metastatic lymph nodes was 24.5%. The total and average number of retrieved mediastinal nodes were 999 and 13.6 ± 6.4/case in the radical dissection group, significantly higher than that in the traditional dissection group (645 and 9.1 ± 4.4/case) (P < 0.001). The average number of retrieved nodes and node metastasis rate in the radical dissection group were significantly higher than in the traditional dissection group (13.1 ± 6.4 versus 9.1 ± 4.4, P < 0.001; 35.5% versus 12.7%, P < 0.05). In the total group of 147 cases, the metastasis rates of periesophageal, subcarinal nodes and nodes along the recurrent laryngeal nerve lymphatic chains were 19.7%, 3.4% and 17.1%, respectively. There was thoracic lymph node metastasis in 27 cases with a metastasis rate of 35.5% in the radical dissection group, significantly higher than that in 9 cases and 12.7% in the traditional dissection group (P > 0.001). In the 1644 retrieved thoracic lymph nodes, there were 90 positive metastatic lymph nodes (metastasis ratio 5.5%). Among the 1644 lymph nodes, the metastasis ratio of periesophageal lymph nodes was 6.5%, subcarinal lymph modes 2.4% and the recurrent laryngeal nerve chain lymph nodes 7.5%. Among the 147 cases, complications occurred in 60 cases, with an overall morbidity rate of 40.8%. There were no significant differences of the incidence rates of overall complications, pulmonary complications and recurrent laryngeal nerve injury between the two groups (P > 0.05).

CONCLUSIONThoracoscopic esophagectomy with radical mediastinal lymphadenectomy is technically Safe and feasible.