title: Thoracolaparoscopic dissection of esophageal lymph nodes without esophagectomy is feasible in human cadavers and safe in a porcine survival study.
abstract: High-risk early esophageal adenocarcinoma (i.e. submucosal invasion >500 nm, poor differentiation, and/or presence of lymphovascular invasion) is currently treated with esophagectomy with lymph node (LN) dissection given the high rates of LN metastases. However, esophagectomy is associated with substantial morbidity and mortality. Endoscopic radical resection followed by thoracolaparoscopic LN dissection without concomitant esophagectomy could be an alternative. The study aim was to evaluate the feasibility and safety of thoracolaparoscopic dissection of esophageal LNs in a preclinical setting. (i) In human cadavers, thoracolaparoscopic dissection of LNs involved in drainage of the esophagus was performed. Subsequently, esophagectomy was performed to be able to detect retained LNs. Outcome parameters included the number of dissected LNs, the number of retained LNs in the esophagectomy specimen (ES), and technical success. (ii) In swine, thoracolaparoscopic LN dissection was also performed. After the procedure, the swine survived for 28 days. Thereafter, the swine were sacrificed and esophagectomy was performed. Outcome parameters included the presence of ischemia and/or stenosis in the ES and other complications. (i) In five human cadavers, a median of 26 LNs (interquartile range 22-46) were dissected. In two ES, one retained LN was found: one high paraesophageal, one low paraesophageal. Technical success rate was 100%. (ii) None of the seven porcine ES showed signs of ischemia or stenosis. One swine died because of ventricular fibrillation during surgery; during follow up no complications were observed. Thoracolaparoscopic dissection of LNs involved in the drainage of the esophagus is feasible in human cadavers and swine. The porcine survival study suggests that the esophageal vascularity is not severely compromised by the procedure. As anatomy differs between swine and humans, safety of the procedure will have to be investigated thoroughly before applying this new technique as the treatment of choice.
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.|Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: H T
authors.initials: HT
authors.lastname: Künzli
authors.affiliation: Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Berge Henegouwen
authors.affiliation: Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Gisbertz
authors.affiliation: Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Seldenrijk
authors.affiliation: Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Kuijpers
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Bergman
authors.affiliation: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Wiezer
authors.affiliation: Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.|Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Weusten
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000818:Animals; D002102:Cadaver; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D004947:Esophagus; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D009367:Neoplasm Staging; D013552:Swine; D013906:Thoracoscopy / Q000379:methods*
keywords: early esophageal adenocarcinoma; lymph node dissection; preclinical study; treatment