Anatomical Evaluation of Possible Extent of Clearing Upper Mediastinal Lymph Nodes for Esophageal Cancer with Right Thoracotomy and Neck Dissection

Abstract

Five cadavers were anatomically evaluated for the possibility of clearing upper mediastinal lymph nodes through right thoracotomy and neck dissection for esophageal cancer. Furthermore, the status of lymph node metastasis in the area difficult to clear due to a limited view of the operative field was pathologically analyzed using 25 cadavers after lymph node dissection in three areas of the neck, thoracic cavity and abdomen. The anatomical study of 5 cadavers revealed that the left sides of the upper mediastinal lymph nodes were completely cleared up to the median sides of the brachiocephalic artery, left common carotid artery, left subclavian artery, and Botallo's ligament. However, clearing the lymph nodes located on the left sides of the aorta, Botallo's ligament and pulmonary artery was very difficult; remaining lymph nodes were found after clearing. In the analysis of the 15 of 25 cadavers that could be evaluated, no metastatic lymph nodes were seen in the left sides of the aortic arch and Botallo's ligament, and therefore clearing these regions was considered not so advantageous. It was concluded that clearing of the upper mediastinal lymph nodes was enough in view of the operative field through right thoracotomy and neck dissection for esophageal cancer.