Two-Field Lymphadenectomy During Esophagectomy: The Presence of Thoracic Duct Lymph Nodes

胸导管切除是常规en bloc纵隔食管癌切除的一部分。随着微创技术的适应,很多中心开始原位保留胸导管。然而,前期的研究表明该区域存在胸导管淋巴结,并可出现转移。

但是,由于不同研究的手术和解剖方式不同,所报道纵隔淋巴结部位、数量等并不明确,鉴于此,来自瑞士的Bernadette Schurink教授等开展了一项研究,该研究旨在评估胸导管周围脂肪组织中的淋巴结数量、位置等信息。

研究者在7例新鲜冷冻尸体上进行经右胸腔镜食管切除术(男性3例;女性4例)。手术中将食管和7,8和9组淋巴结整块切除,然后切除覆盖主动脉的剩余脂肪组织,将胸导管和胸导管淋巴结一并切除。淋巴结通过苏木素-伊红染色观察,并从宏观和微观上进行计数。

研究者发现,6/7(86%)例尸体上发现胸导管淋巴结,中位数为1(范围0-6)。淋巴结主要位于奇静脉区域。中位隆突下淋巴结为4个(1-8),食管旁淋巴结为2个(1-4)。

所以研究者认为,胸导管淋巴结主要位于胸导管周围的脂肪组织内。所以在食管切癌切除术中应重视增加该区域淋巴结的切除。

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.

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