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Lymph node metastasis is one of the most important prognostic factors in esophageal squamous cell carcinoma. However, the optimal extent of lymph node dissection is still under debate. We specifically address several controversies regarding lymph node dissection, for example, recurrent laryngeal node lymphadenectomy, cervical lymphadenectomy, and thoracic duct resection, in esophageal squamous cell carcinoma. We also describe new concepts in surgical anatomy of the upper mediastinum and technologies, for example, near-infrared image-guided lymphatic mapping and intraoperative neural monitoring that facilitate recurrent laryngeal node lymphadenectomy.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jtcvs.2007.11.007 Byline: Po-Kuei Hsu (a), Anna Fen-Yau Li (b), Yi-Ching Wang (c), Chih-Cheng Hsieh (a), Min-Hsiung Huang (a), Wen-Hu Hsu (a), Han-Shui Hsu (a) Abbreviations: ESCC, esophageal squamous cell carcinoma; GSK3[beta], glycogen synthase kinase 3[beta] Abstract: The aim of this study was to evaluate, by immunohistochemical analysis, the protein expression of [beta]-catenin and p53 in resected esophageal squamous cell carcinoma specimens. The clinical relevance and prognostic significance of the expression of these proteins were also analyzed. Author Affiliation: (a) Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (b) Department of Pathology, Taipei Veterans General Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan (c) Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan, Taiwan Article History: Received 10 July 2007; Revised 29 August 2007; Accepted 9 November 2007

To compare the perioperative outcomes of single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy.

A 35-year-old previous healthy man presented with palpitations and nearly syncope. Electrocardiography showed first degree atrioventricular block (PR interval 316 milliseconds) and premature ventricular complex (PVC) possibly originating from right ventricle (RV). The transthoracic echocardiography disclosed dilated RV with preserved right ventricular systolic function with a RV systolic pressure of 33mmHg, and thickened interventricular septum (12.7mm) with normal left ventricular size and function. At this point, the initial diagnosis was arrhythmogenic right ventricular cardiomyopathy (ARVC) with ventricular arrhythmias. The 24-hour Holter study showed 904 monomorphic PVCs and short-run ventricular tachycardia. The chest computed tomography demonstrated dilated RV with scalloping over free wall and multiple lung nodules mainly located in both upper lung fields (Figure A&B). Radiofrequency catheter ablation and implantation of implantable cardioverter defibrillator were suggested under the impression of ARVC. Therefore, he visited our hospital for second opinion. Since the diseased conduction system was unusual in patient with ARVC, CMR imaging was performed which revealed late gadolinium enhancement over both ventricles and basal interventricular septum (Figure C), raising the suspicion of cardiac sarcoidosis. Thereafter, the 18F-fluorodeoxyglucose (FDG)-Positron Emission Tomography study was arranged and showed FDG uptake over basal septum and lateral wall of LV, and multiple lung nodules (Figure D). Endomyocardial biopsy of RV showed myocardial fibrosis without a specific diagnosis. Thoracoscopic wedge resection of the lung nodule was performed, and pathology showed non-necrotizing granulomas distributed along with broncho-vascular bundles and subpleural area. No microorganism could be demonstrated. Sarcoidosis with cardiac and pulmonary involvement was impressed. Further steroid treatment will be initiated.

While preoperative chemoradiation followed by surgery (pre-OP CRT) has been widely applied in the treatment of patients with esophageal cancer, some studies have shown a survival benefit of postoperative chemoradiation (post-OP CRT). The optimal combination of multimodality therapy and the sequence of surgery and chemoradiation for esophageal cancer remain to be investigated.