Feasibility and strategy for left tracheobronchial lymph node dissection in thoracolaparoscopic esophageal cancer surgery

Background This study evaluates the feasibility and strategy of left tracheobronchial lymph node ( LN ) dissection in the surgical treatment of esophageal cancer, and its impact on surgical outcomes following thoracoscopic esophagectomy. Methods Data of 265 patients with thoracic esophageal cancer who underwent thoracoscopic and laparoscopic esophagectomy was retrospectively reviewed. In 80 cases, thoracoscopic esophagectomy was performed without left tracheobronchial LN dissection (group non‐4 L ), while 185 cases underwent thoracoscopic esophageal mobilization with routine left tracheobronchial node dissection (group 4 L ). We introduced a “mesoesophageal suspension” method in order to facilitate complete dissection of the left tracheobronchial nodes, along with left recurrent laryngeal nerve nodes. Both univariate and multivariate analyses were performed to evaluate risk factors correlated to left tracheobronchial node metastasis. Results The non‐4 L group experienced less blood loss than the 4 L group ( P = 0.009). More mediastinal LNs were dissected in the 4 L group ( P < 0.001). There was no significant difference with regard to the incidence of major postoperative complications between the two groups. Compared with other LN metastases, the metastatic rate of the left tracheobronchial LNs was relatively lower. Based on multivariate analysis of six factors, lymphatic invasion and subcarinal node metastasis were shown to be strong independent predictors of left tracheobronchial metastasis. Conclusion Routine thoracoscopic extensive lymphadenectomy, including the left tracheobronchial LN , was technically feasible and safe in patients with esophageal cancer. Using a mesoesophagus suspension technique, we performed a meticulous LN dissection in the upper mediastinal space.