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

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 differ 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 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 difficult, 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.