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. 2022 Sep;13(17):2436-2442.
doi: 10.1111/1759-7714.14554. Epub 2022 Jul 18.

How to distinguish thoracic and cervical lymph nodes during minimally invasive esophagectomy

Taidui Zeng #  1   2 , Maohui Chen #  1   2 , Bingqiang Cai  1   2 , Wei Zheng  1   2 , Chi Xu  1   2 , Guobing Xu  1   2 , Chun Chen  1   2 , Bin Zheng  1   2
Affiliations

How to distinguish thoracic and cervical lymph nodes during minimally invasive esophagectomy

Taidui Zeng et al. Thorac Cancer. 2022 Sep.

Abstract

Purpose: In this article, we aimed to reconstruct the cervical-thoracic junction plane (CTJP) using a three-dimensional (3D) reconstruction system. Thus, the CTJP can be judged during surgery to better distinguish cervical-thoracic lymph nodes.

Methods: We included patients in Fujian Medical University Union Hospital from December 2019 to March 2020. All patients underwent a thin-slice and enhanced computed tomography scan of the chest with 3D reconstruction using the IQQA system (EDDA technology) to reconstruct the CTJP, brachiocephalic trunk, right common carotid artery, and right subclavian artery. The distance from the intersection of the right subclavian artery and the CTJP to the origin of the right subclavian artery (ORSA) was measured, and the relationship between this distance and the patient's sex, BMI and height was analyzed.

Results: Seventy-three patients were enrolled, of whom 12 had ORSA above the CTJP, while 61 had ORSA below the plane. There was a significant difference in age between the two groups (p = 0.04), compared with height, weight and BMI (p > 0.05). In 61 patients with the ORSA below the CTJP, the average distance was 24.7 ± 7.6 mm. The difference between the distance and BMI (p = 0.02) was statistically significant, and it was increased with increasing BMI.

Conclusions: The relationship between the ORSA and CTJP can be clarified through 3D reconstruction. The cervical-thoracic recurrent laryngeal nerve lymph nodes can be distinguished clearly in minimally invasive esophagectomy, contributing to the accurate N staging of middle-thoracic esophageal cancer.

Keywords: esophageal cancer; thoracic and cervical lymph nodes; three-dimensional reconstruction.

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Conflict of interest statement

We declare that there is no conflict of interest.

Figures

FIGURE 1
FIGURE 1
The reconstruction effect. (a–c) The ORSA located below the CTJP. (a) The brachiocephalic trunk, right common carotid artery, RSA. (b) The CTJP and the intersection of the RSA and the CTJP (point B). (c) The distance between point A (ORSA) and point B (the intersection of the RSA and the CTJP) was measured (as shown in this figure, the distance for this patient is 25.8 mm). (d) The ORSA located above the CTJP. RSA, right subclavian artery; ORSA, origin of the right subclavian artery; CTJP, cervical–thoracic junction plane
FIGURE 2
FIGURE 2
The changing trend in distance between different BMI groups
FIGURE 3
FIGURE 3
How to judge 2.5 cm during surgery. (a) The distance from the opening of the tail of the gastric forceps during esophageal cancer surgery is approximately 2.5 cm. (b) We dissected the right subclavian artery and the right common carotid artery, then we determined the position of the ORSA. (c) When the lower end was in the ORSA position (point A), the upper end (point B) was in the position of the CTJP
See this image and copyright information in PMC

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