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Lymph Node Dissection along the Recurrent Laryngeal Nerve in Video-Assisted Thoracoscopic Surgery (VATSE) for Esophageal Squamous Cell Carcinoma [chapter]

Hiroshi Makino, Hiroshi Yoshida, Eiji Uchida
2017 Esophageal Abnormalities  
Esophageal carcinoma is the ninth most common cancer in the world, which is frequently seen in Asia and east Africa. Around 80% of all cases occurred in less-developed regions. Two major histological subtypes of esophageal carcinoma, adenocarcinoma and squamous cell carcinoma, are known to difer greatly in terms of risk factor, epidemiology, male to female ratios, and incidence. Lymph node metastasis is a crucial factor in staging and prognosis is associated with surgical treatment and a major
more » ... atment and a major lymphatic chain into the neck. Esophageal adenocarcinoma (EAC) is mainly detected at the lower third of the thoracic esophagus or esophago-gastric-junction (EGJ) and metastasizes mainly to lymph nodes of the lesser sac, celiac regions and lower mediastinal. Esophageal squamous cell carcinoma (ESCC) has a predilection for metastasis to the lymph nodes of the cervical region including recurrent laryngeal nerve (RLN) on both sides. Lymph node dissection is vital yet diicult, left-side lymph node dissection especially requires expertise. There are some reports on lymph node dissection in the prone position by video-assisted thoracoscopic surgery of the esophagus (VATS-E) along the left RLN in Japan and China. We also introduce a stripping method for lymph node dissection in this site. Esophageal carcinoma is seen in two major histological subtypes: adenocarcinoma and squamous cell carcinoma (SCC). These subtypes are very diferent in terms of risk factors and epidemiology. According to GLOBOCAN 2012, there were an estimated 400,000 cases of ESCC and 50,000 cases of EAC of the esophagus in 2012 worldwide [4]. Global incidence of ESCC In 2012, the global incidence of ESCC was 5.2 per 100,000 people. Most afected regions were located in Eastern and South-East Asia, followed by sub-Saharan Africa and Central Asia [4] . About 80% of global ESCC cases occur in Central and South-East Asian regions. China alone provided more than 50% of the global cases. Areas of high incidence of ESCC have been identiied in Northern Iran, Central Asia, and China (together forming the so-called "esophageal cancer belt") as well as parts of Eastern Africa. ESCC is more common and the rate of ESCC is about 95% in Japan [3]. Risk factor of ESCC Generally, chronic inlammation of the esophageal mucosa is postulated to increase the risk of ESCC. Two major risk factors are smoking and alcohol consumption, which have been found Esophageal Abnormalities 74 Esophageal Abnormalities 84
doi:10.5772/intechopen.69524 fatcat:n4oshi2fgzeifhhwom527ixu5q