Application of modified lymph node dissection around recurrent laryngeal nerve in thoracoscopic surgery for middle and lower esophageal cancer at stage Ⅱ-Ⅲ

ZHANG Yanfeng; LI Xiaoming; ZHENG Zhixin

doi:10.3969/j.issn.1009-0460.2025.01.011

Abstract：Objective To explore the effect and complication of modified lymph node dissection around recurrent laryngeal nerve in thoracoscopic surgery for middle and lower esophageal cancer at stage Ⅱ-Ⅲ.Methods A total of 74 patients with stage Ⅱ-Ⅲ middle and lower esophageal cancer from January 2021 to March 2023 were collected and randomly divided into the control group(thoracoscopic three-field dissection radical esophagectomy+lymph node dissection,n=38)and the observation group(thoracoscopic three-field dissection radical esophagectomy+modified recurrent laryngeal nerve adjacent lymph node dissection,n=36).The recurrence,surgical-related indicators,serum-related indicators,quality of life and complication occurrence were compared between the two groups.Results By the end of the follow-up,the 1-year and 3-year recurrence-free survival rates in the observation group were 77.8%and 63.9%,respectively,which were higher than 55.3%and 39.5%in the control group,and the difference was statistically significant(P=0.035).The number of lymph nodes dissected in the observation group was(7.13±0.54),which was more than(4.76±0.43)in the control group(P<0.001).The time for dissecting lymph nodes beside the recurrent laryngeal nerve in the observation group was(10.87±0.65)min,which was shorter than(13.43±1.03)min in the control group(P<0.001).Compared with preoperative levels,the scores of quality of life indicators in both groups increased,and the increase was more significant in the observation group(P<0.05).Compared with preoperative levels,the levels of serum vascular endothelial growth factor(VEGF),carbohydrate antigen 19-9(CA19-9),cytokeratin 19 fragment(CYFRA21-1),carbohydrate antigen 125(CA125),and squamous cell carcinoma-associated antigen(SCC-Ag)in both groups decreased,and the decrease was more obvious in the observation group(P<0.05).The main complications in the both groups included recurrent laryngeal nerve injury,pulmonary infection,aspiration cough and hoarseness.The complication rate in the control group was 36.8%(14/38),and that in the observation group was 11.1%(4/36),and the difference between the two groups was statistically significant(P<0.05).There were 3 cases of recurrent laryngeal nerve injury in the control group and 1 case in the observation group.Conclusion Patients with stageⅡ-Ⅲ of middle and lower esophageal cancer treated by thoracoscopic surgery and modified lymph node dissection around the recurrent laryngeal nerve can prolong the recurrence-free survival and reduce the occurrence of complications.