593. UPPER MEDIASTINAL LYMPHADENECTOMY IN PRONE POSITION TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY. (24th September 2022) - Davakis, Spyridon
Abstract: Minimally invasive esophagectomy (MIE) is a challenging procedure associated with high rate of complications and mortality. Routine lymphadenectomy includes 2-field lymphadenectomy for distal esophageal or esophago-gastric junction Siewert I-II cancers. SML refers to extended 2-field lymphadenectomy or total mediastinal lymphadenectomy. The exact benefits of superior mediastinal lymphadenectomy (SML) have long been debated with no clear evidence pertaining to improved outcomes. N=150 consecutive patients underwent totally MIE under a surgical team from September 2016 to September 2020. SML included right paratracheal nodes and lymph nodes along the right recurrent laryngeal nerve throughout its mediastinal route (including the paratracheal-retrocaval compartment) in cases of extended 2-field lymphadenectomy, as well as left paratracheal nodes and lymph nodes along the left recurrent laryngeal nerve during total mediastinal lymphadenectomy. Eligible patients underwent SML during 2-stage or 3-stage MIE. N=20 consecutive cases were identified as eligible according to the inclusion criteria during the study period. 30- and 90- day mortality rates were 0. There were no anastomotic or chyle leaks noted. Pulmonary complications were observed in 16.5% of the patients. There was 1 right recurrent laryngeal nerve palsy noted. Median length of hospital stay was 9 days. Median number of resected lymph nodes was 45 (Range: 37-68), with median SML nodes count being 8 (Range: 2-25). Median follow up was 24 months. The small sample size is immediately recognised as a limiting and influencing factor in the results of this study. However, MIOs with SML may provide some, although not comprehensive, benefit in oncological outcomes without adding any further significant morbidity. Larger studies are needed to assess the role SML can play in improving patient outcomes.