TY - JOUR
T1 - Two-Field Lymphadenectomy During Esophagectomy
T2 - The Presence of Thoracic Duct Lymph Nodes
AU - Schurink, Bernadette
AU - Defize, Ingmar L.
AU - Mazza, Elena
AU - Ruurda, Jelle P.
AU - Brosens, Lodewijk A.A.
AU - Roeling, Tom A.P.
AU - Bleys, Ronald L.A.W.
AU - van Hillegersberg, Richard
N1 - Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct. Methods: A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically. Results: Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present. Conclusions: This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.
AB - Background: Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct. Methods: A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically. Results: Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present. Conclusions: This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.
UR - http://www.scopus.com/inward/record.url?scp=85049346226&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2018.02.047
DO - 10.1016/j.athoracsur.2018.02.047
M3 - Article
C2 - 29580778
SN - 0003-4975
VL - 106
SP - 435
EP - 439
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -