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Should lymph nodes along the thoracic duct be dissected routinely in radical esophagectomy?

机译：根治性食管切除术应常规切除沿胸导管的淋巴结吗？

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Background Although dissection of mediastinal lymph nodes along the thoracic duct is included in standard radical esophagectomy, it is not routinely performed because of the undesirable hemodynamic effects. This study aims to investigate whether dissection of the nodes along the thoracic duct has prognostic benefits. Methods A total of 778 consecutive patients who underwent radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma of the thoracic esophagus from 1984 to 2011 were included. The incidence of metastasis in thoracic duct nodes and that in nodes within #112 station excluding thoracic duct nodes were studied in relation to the depth of the main tumor. The survival curves of lymph node-positive patients were compared. Results The metastatic incidence was 2.2 % in Tlb/T2, whereas it was 10.0 % in T3/T4. The survival curves in patients with metastasis in the thoracic duct nodes and in the #112 station were not statistically different. Conclusion The dissection of the nodes along the thoracic duct along with thoracic duct resection should be performed routinely; however, reliable indicator of the necessity of its dissection is awaited in Tlb/T2 tumors because of the low metastatic rate and the potential risk associated with resection of the thoracic duct.
机译：背景技术尽管标准的根治性食管切除术包括沿胸导管纵隔淋巴结清扫，但由于不良的血液动力学效应，常规不进行此操作。这项研究旨在调查沿胸导管的淋巴结清扫是否对预后有帮助。方法1984年至2011年，共纳入778例行胸腔食管鳞状细胞癌的三期淋巴结清扫术。研究了与主要肿瘤深度相关的胸导管结和＃112站内除胸导管结以外的转移发生率。比较了淋巴结阳性患者的生存曲线。结果Tlb / T2的转移率为2.2％，而T3 / T4的转移率为10.0％。胸导管结和＃112台转移患者的生存曲线无统计学差异。结论应常规行胸导管切开术，并行胸导管切除术。然而，由于转移率低和与胸导管切除术相关的潜在风险，在Tlb / T2肿瘤中尚需对其进行解剖的可靠指标。

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