食管鳞状细胞癌喉返神经旁淋巴结的重要性及清扫技术要点

doi:10.3760/cma.j.cn371439-20210617-00094

摘要/Abstract

摘要：

喉返神经旁淋巴结(RLN LN)不仅是食管鳞状细胞癌转移的最常见部位,而且是影响患者预后的关键因素。RLN LN是颈部淋巴结转移的可靠预测指标,其状态决定是否进行颈部淋巴结清扫。但由于其手术范围广、创伤大、术后并发症发生率高等不利因素,因此筛选出获益人群非常重要。

关键词: 食管肿瘤, 喉返神经旁淋巴结, 颈部淋巴结, 三野淋巴结清扫术

Abstract:

Recurrent laryngeal nerve lymph node (RLN LN) is not only the most common site of esophageal squamous cell carcinoma metastasis, but also a key factor affecting the prognosis of patients. RLN LN is a reliable predictor of cervical lymph node metastasis, and its status determines whether cervical lymph node dissection should be performed. However, because of its wide range of operations, large trauma and high incidence of postoperative complications, it is very important to screen out the beneficiaries.

Key words: Esophageal neoplasms, Recurrent laryngeal nerve lymph node, Cervical lymph node, Three field lymph node dissection

赵方超. 食管鳞状细胞癌喉返神经旁淋巴结的重要性及清扫技术要点[J]. 国际肿瘤学杂志, 2021, 48(8): 494-497.

Zhao Fangchao. Importance of recurrent laryngeal nerve lymph node in esophageal squamous cell carcinoma and the key points of dissection technique[J]. Journal of International Oncology, 2021, 48(8): 494-497.

参考文献 35

[1]	Nakajima Y, Tokairin Y, Nakajima Y, et al. Anatomical study of the left superior mediastinal lymphatics for tracheal branches of left recurrent laryngeal nerve-preserving mediastinoscope-assisted surgery in esophageal cancer[J]. Surg Today, 2018,48(3):333-337. DOI: 10.1007/s00595-017-1600-0. doi: 10.1007/s00595-017-1600-0 pmid: 29052783
[2]	Tachimori Y. Pattern of lymph node metastases of squamous cell esophageal cancer based on the anatomical lymphatic drainage system: efficacy of lymph node dissection according to tumor location[J]. J Thorac Dis, 2017,9(18):S724-S730. DOI: 10.21037/jtd.2017.06.19. doi: 10.21037/jtd.2017.06.19
[3]	王镇, 柳硕岩. 食管胸中段鳞癌喉返神经旁淋巴结清扫的临床价值[J]. 中华胃肠外科杂志, 2015,18(9):867-870. DOI: 10.3760/cam.j.issn.1671-0274.2015.09.005. doi: 10.3760/cam.j.issn.1671-0274.2015.09.005
[4]	翁军玲, 田辉, 李鲁波. 食管癌患者胸内喉返神经旁淋巴结转移与颈部淋巴结的关联性[J]. 世界华人消化杂志, 2016,24(16):2537-2542. DOI: 10.11569/wcjd.v24.i16.2537. doi: 10.11569/wcjd.v24.i16.2537
[5]	袁立功, 毛友生. 胸段食管癌喉返神经旁淋巴结转移对食管癌颈部淋巴结清扫的指导价值[J]. 中华肿瘤杂志, 2019,41(1):10-14. DOI: 10.3760/cma.j.issn.0253-3766.2019.01.003. doi: 10.3760/cma.j.issn.0253-3766.2019.01.003
[6]	Xu J, Zheng B, Zhang S, et al. The clinical significance of the intraoperative pathological examination of bilateral recurrent laryngeal nerve lymph nodes using frozen sections in cervical field lymph node dissection of thoracic esophageal squamous cell carcinoma[J]. J Thorac Dis, 2019,11(8):3525-3533. DOI: 10.21037/jtd.2019.07.59. doi: 10.21037/jtd.2019.07.59
[7]	Otsuka K, Murakami M, Goto S, et al. Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis[J]. Surg Endosc, 2020,34(6):2749-2757. DOI: 10.1007/s00464-020-07372-3. doi: 10.1007/s00464-020-07372-3 pmid: 32016515
[8]	Udagawa H, Ueno M, Shinohara H, et al. The importance of grou-ping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer[J]. J Surg Oncol, 2012,106(6):742-747. DOI: 10.1002/jso.23122. doi: 10.1002/jso.23122
[9]	Udagawa H. Past, present, and future of three-field lymphadenectomy for thoracic esophageal cancer[J]. Ann Gastroenterol Surg, 2020,4(4):324-330. DOI: 10.1002/ags3.12338. doi: 10.1002/ags3.12338
[10]	Wang J, Yang Y, Shafiulla Shaik M, et al. three-field versus two-field lymphadenectomy for esophageal squamous cell carcinoma: a meta-analysis[J]. J Surg Res, 2020,255:195-204. DOI: 10.1016/j.jss.2020.05.057. doi: 10.1016/j.jss.2020.05.057
[11]	Shang QX, Chen LQ, Hu WP, et al. Three-field lymph node dissection in treating the esophageal cancer[J]. J Thorac Dis, 2016,8(10):E1136-E1149. DOI: 10.21037/jtd.2016.10.20. doi: 10.21037/jtd.2016.10.20
[12]	Ye T, Sun Y, Zhang Y, et al. Three-field or two-field resection for thoracic esophageal cancer: a meta-analysis[J]. Ann Thorac Surg, 2013,96(6):1933-1941. DOI: 10.1016/j.athoracsur. doi: 10.1016/j.athoracsur
[13]	Li B, Hu H, Zhang Y, et al. Three-field versus two-field lymphadenectomy in transthoracic oesophagectomy for oesophageal squamous cell carcinoma: short-term outcomes of a randomized clinical trial[J]. Br J Surg, 2020,107(6):647-654. DOI: 10.1002/bjs.11497. doi: 10.1002/bjs.11497 pmid: 32108326
[14]	柳硕岩, 朱坤寿, 郑庆丰, 等. 三野与二野淋巴结清扫对胸段食管鳞癌患者术后生存的影响[J]. 中华胸心血管外科杂志, 2014,30(11):645-648. DOI: 10.3760/cma.j.issn.10014497.2014.11.002. doi: 10.3760/cma.j.issn.10014497.2014.11.002
[15]	Tan Z, Ma G, Zhao J, et al. Impact of thoracic recurrent laryngeal node dissection: 508 patients with tri-incisional esophagectomy[J]. J Gastrointest Surg, 2014,18(1):187-193. DOI: 10.1007/s11605-013-2411-2. doi: 10.1007/s11605-013-2411-2
[16]	Koterazawa Y, Oshikiri T, Takiguchi G, et al. Prophylactic cervical lymph node dissection in thoracoscopic esophagectomy for esophageal cancer increases postoperative complications and does not improve survival[J]. Ann Surg Oncol, 2019,26(9):2899-2904. DOI: 10.1245/s10434-019-07499-1. doi: 10.1245/s10434-019-07499-1 pmid: 31187365
[17]	Liu J, Wang Z, Shao H, et al. Improving CT detection sensitivity for nodal metastases in oesophageal cancer with combination of smaller size and lymph node axial ratio[J]. Eur Radiol, 2018,28(1):188-195. DOI: 10.1007/s00330-017-4935-4. doi: 10.1007/s00330-017-4935-4
[18]	Liu M, Chen Y, Fu X, et al. Proposed revision of CT-based cervical and thoracic lymph node levels for esophageal cancer in UICC 7th version[J]. Radiother Oncol, 2014,113(2):175-181. DOI: 10.1016/j.radonc.2014.11.022. doi: 10.1016/j.radonc.2014.11.022
[19]	Wang GM, Liu DF, Xu YP, et al. PET/CT imaging in diagnosing lymph node metastasis of esophageal carcinoma and its comparison with pathological findings[J]. Eur Rev Med Pharmacol Sci, 2016,20(8):1495-1500.
[20]	Shi W, Wang W, Wang J, et al. Meta-analysis of ¹⁸FDG PET-CT for nodal staging in patients with esophageal cancer[J]. Surg Oncol, 2013,22(2):112-116. DOI: 10.1016/j.suronc.2013.02.003. doi: 10.1016/j.suronc.2013.02.003
[21]	Pech O, Günter E, Dusemund F, et al. Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer: results from a referral center for early esophageal cancer[J]. Endoscopy, 2010,42(6):456-461. DOI: 10.1055/s-0029-1244022. doi: 10.1055/s-0029-1244022 pmid: 20306385
[22]	Harewood GC, Kumar KS. Assessment of clinical impact of endoscopic ultrasound on esophageal cancer[J]. J Gastroenterol Hepatol, 2004,19(4):433-439. DOI: 10.1111/j.1440-1746.2003.03304.x. doi: 10.1111/j.1440-1746.2003.03304.x
[23]	van Zoonen M, van Oijen MG, van Leeuwen MS, et al. Low impact of staging EUS for determining surgical resectability in esophageal cancer[J]. Surg Endosc, 2012,26(10):2828-2834. DOI: 10.1007/s00464-012-2254-z. doi: 10.1007/s00464-012-2254-z pmid: 22692460
[24]	Puli SR, Reddy JB, Bechtold ML, et al. Staging accuracy of eso-phageal cancer by endoscopic ultrasound: a meta-analysis and systematic review[J]. World J Gastroenterol, 2008,14(10):1479-1490. DOI: 10.3748/wjg.14.1479. doi: 10.3748/wjg.14.1479
[25]	Dyer SM, Levison DB, Chen RY, et al. Systematic review of the impact of endoscopic ultrasound on the management of patients with esophageal cancer[J]. Int J Technol Assess Health Care, 2008,24(1):25-35. DOI: 10.1017/S026646230708004X. doi: 10.1017/S026646230708004X
[26]	Fujiwara H, Kanamori J, Nakajima Y, et al. An anatomical hypo-journal: a "concentric-structured model" for the theoretical understanding of the surgical anatomy in the upper mediastinum required for esophagectomy with radical mediastinal lymph node dissection[J]. Dis Esophagus, 2019, 32(8): doy119. DOI: 10.1093/dote/doy119. doi: 10.1093/dote/doy119
[27]	Mori K, Aikou S, Yagi K, et al. Technical details of video-assisted transcervical mediastinal dissection for esophageal cancer and its perioperative outcome[J]. Ann Gastroenterol Surg, 2017,1(3):232-237. DOI: 10.1002/ags3.12022. doi: 10.1002/ags3.12022
[28]	Lin M, Shen Y, Wang H, et al. Recurrent laryngeal nerve lymph node dissection in minimally invasive esophagectomy[J]. J Vis Surg, 2016,2:164. DOI: 10.21037/jovs.2016.10.02. doi: 10.21037/jovs.2016.10.02
[29]	Duan X, Yue J, Chen C, et al. Lymph node dissection around left recurrent laryngeal nerve: robot-assisted vs. video-assisted McKeown esophagectomy for esophageal squamous cell carcinoma[J]. Surg Endosc, 2020: 1-9. DOI: 10.1007/s00464-020-08105-2. doi: 10.1007/s00464-020-08105-2
[30]	杨智, 杨力涛, 贾永, 等. 微创食管癌手术“镂空法”清扫双侧喉返神经链旁淋巴结39例[J]. 中国微创外科杂志, 2019,19(1):81-83. DOI: 10.3969/cma.j.issn.1009-6604.2019.10.022. doi: 10.3969/cma.j.issn.1009-6604.2019.10.022
[31]	Oshikiri T, Nakamura T, Miura Y, et al. Practical surgical techniques for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position[J]. Ann Surg Oncol, 2017,24(8):2302. DOI: 10.1245/s10434-017-5879-2. doi: 10.1245/s10434-017-5879-2 pmid: 28510799
[32]	Zhong D, Zhou Y, Li Y, et al. Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal can-cer[J]. Dis Esophagus, 2014,27(5):444-451. DOI: 10.1111/j.1442-2050.2012.01414.x. doi: 10.1111/j.1442-2050.2012.01414.x pmid: 23020300
[33]	Taniyama Y, Miyata G, Kamei T, et al. Complications following recurrent laryngeal nerve lymph node dissection in oesophageal cancer surgery[J]. Interact Cardiovasc Thorac Surg, 2015,20(1):41-46. DOI: 10.1093/icvts/ivu336. doi: 10.1093/icvts/ivu336
[34]	Koyanagi K, Igaki H, Iwabu J, et al. Recurrent laryngeal nerve paralysis after esophagectomy: respiratory complications and role of nerve reconstruction[J]. Tohoku J Exp Med, 2015,237(1):1-8. DOI: 10.1620/tjem.237.1. doi: 10.1620/tjem.237.1 pmid: 26268885
[35]	Gelpke H, Grieder F, Decurtins M, et al. Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection[J]. World J Surg, 2010,34(10):2379-2382. DOI: 10.1007/s00268-010-0692-0. doi: 10.1007/s00268-010-0692-0 pmid: 20563722