Salvage Lymphadenectomy of the Right Recurrent Nerve Node with Tracheal Involvement After Definitive Chemoradiation Therapy for Esophageal Squamous Cell Carcinoma: Report of Two Cases |
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Authors: | Yuichiro Doki Takushi Yasuda Hiroshi Miyata Yoshiyuki Fujiwara Shuji Takiguchi Makoto Yamasaki Yoichi Makari Jin Matsuyama Takeshi Masuoka Morito Monden |
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Institution: | (1) Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka 565-0871, Japan;(2) Department of Plastic Surgery, Graduate School of Medicine, Osaka University, 2-2-E2 Yamadaoka, Suita, Osaka 565-0871, Japan |
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Abstract: | Thoracic esophageal cancers frequently metastasize to the right recurrent nerve nodes (RRNNs). In fact, huge RRNNs invading
the trachea sometimes remain after definitive chemoradiation therapy (CRT), despite complete remission of the primary lesion.
We performed salvage lymphadenectomy of a large RRNN combined with partial resection of the trachea in two patients. Using
an anterior approach, we removed part of the sternum, clavicle, and the first and second costal cartilage; then, we removed
the RRNNs with combined resection of the lateral quarter circumference of the trachea, the esophageal wall, and the recurrent
nerve. Reconstruction was done with a musculocutaneous patch of major pectoral muscle to cover the tracheal defect. The only
minor complication was venous thrombosis in one patient. Thus, combined removal of the RRNN and trachea was performed safely
as a salvage operation after definitive CRT for esophageal squamous cell carcinoma. |
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Keywords: | Esophageal cancer Chemoradiation Salvage surgery |
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