The interpretation of the Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition) / 中华胃肠外科杂志

ABSTRACT

At present, there is still no general consensus on the thoracic lymph node classification and dissection standard of esophageal cancer, and its indications, surgical approaches, harvested number and scopes are still the debated focuses in the academic circle. Therefore, the Society of Esophageal Tumor, Chinese Anti-Cancer Association organized experts in the field to write the Chinese expert consensus on mediastinal lymph node dissection in esophagectomy for esophageal cancer (2017 edition) based on clinical experience and current available evidence. This article focuses on the surgical approach and recurrent laryngeal nerve lymph node dissection in esophageal cancer. The right thoracic approach is recommended for wide application in clinical practice by the authors because of the high resection rate and the advantages of more stations and higher number. But the left thoracic approach should not be eliminated and can be used cautiously to some particular patient. Because the metastatic rate of bilateral recurrent laryngeal nerve lymph node in thoracic esophageal cancer is very high, it is classified as the first and the second group of thoracic lymph nodes. Hence, the authors strongly recommend that bilateral recurrent laryngeal nerve lymph node dissection should be performed for all the esophageal cancer patients. The 3-field or 2 and a half field dissection can be performed by right thoracic approach. The bilateral recurrent laryngeal nerve lymph nodes must be cleaned, and the decision of neck dissection should be made accordingly.