Original article
General thoracic
Two-Field Lymphadenectomy During Esophagectomy: The Presence of Thoracic Duct Lymph Nodes

https://doi.org/10.1016/j.athoracsur.2018.02.047Get rights and content

Background

Resection of the thoracic duct is part of the formal en bloc mediastinal esophagolymphadenectomy for cancer, although with the adaptation of minimally invasive techniques, some centers started to leave the thoracic duct compartment in situ. However, previous studies reported thoracic duct lymph nodes in this compartment that may contain metastasis. The aim of this study was to assess the presence and number of lymph nodes in the fatty tissue surrounding the thoracic duct.

Methods

A right-sided thoracoscopic esophagectomy was performed on seven fresh-frozen human cadavers (male, n = 3; female, n = 4). The esophagus and lymph node stations 7, 8, and 9 were resected en bloc, followed by resection of the thoracic duct compartment consisting of the fatty tissue covering the aorta, the thoracic duct and thoracic duct lymph nodes. Lymph nodes were visualized by a hematoxylin and eosin stain and counted macroscopically and microscopically.

Results

Thoracic duct lymph nodes were found in 6 of 7 cadavers (86%), with a median number of 1 (range, 0 to 6). Nodes were predominantly located in the area of the azygos vein. A median of 4 subcarinal nodes (range, 1 to 8) and 2 periesophageal nodes (range, 1 to 4) were present.

Conclusions

This study shows that thoracic duct lymph nodes are located within the fatty tissue surrounding the thoracic duct. Resection of this compartment during an esophagectomy for cancer increases lymph node yield.

Section snippets

Material and Methods

Seven adult fresh-frozen human cadavers (male, n = 3; female, n = 4) without signs of previous thoracic surgery were used for dissection. All cadavers entered the Anatomy Department, University Medical Center Utrecht, The Netherlands, through a donation program. Informed consent was obtained during life.

Results

Three male cadavers (43%) and 4 female cadavers (57%) underwent transthoracic esophagolymphadenectomy (step 1) with separate resection of the thoracic duct with the surrounding fatty tissue (step 2).

Comment

This study shows that the fatty tissue surrounding the thoracic duct contains lymph nodes, predominantly located near the arch of the azygos vein. To the best of our knowledge, this is the first study to give an anatomic description of number and location of TDLN in light of a standardized surgical esophageal resection, making these findings applicable in clinical practice. A study has shown that dissection of the TD and surrounding fatty tissue is feasible with minimally invasive techniques

References (22)

  • J.P. Liu et al.

    Influence of thoracic duct ligation on the lipid metabolism of patients with esophageal carcinoma after esophagectomy

    Genet Mol Res

    (2015)
  • Cited by (17)

    • The Presence of Metastatic Thoracic Duct Lymph Nodes in Western Esophageal Cancer Patients: A Multinational Observational Study

      2022, Annals of Thoracic Surgery
      Citation Excerpt :

      The current report demonstrates that extending the standard thoracic lymphadenectomy with resection of the TD compartment is feasible in open as well as robot-assisted minimally invasive esophageal surgery. Standardized steps for TD compartment resection have been described, and the anatomical borders of the TD compartment allow for a clear identification and meticulous dissection.5 Therefore, adding the resection of TD compartment to an existing procedure is relatively straightforward.

    View all citing articles on Scopus
    View full text