Esophageal Cancer by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783319918303
Publisher: Springer International Publishing

The esophagus is dissected away from the membranous part of the trachea until the left side of the cartilaginous trachea C-ring is reached. The trachea is rotated and retracted anteriorly and the esophagus is pulled posteriorly by the sling to expose the left tracheoesophageal groove. With blunt dissection, the left recurrent laryngeal nerve should be identified along the left side of the trachea. The sympathetic nerve runs in parallel to and sometimes mimics the left recurrent laryngeal nerve . The integrity and location of the nerve can be checked by nerve stimulator (Fig. 11.2). Extra care should be taken in subaortic lymph node dissection to prevent injury to the pulmonary artery, which is potentially lethal. The whole thoracic esophageal dissection is now completed. A Fr 24 chest drain is inserted towards the apex. The authors prefer a Fr 19 round fluted drain connected to vacuum drainage. This is much more comfortable and allows easy ambulation. A formal chest tube is only inserted when extensive adhesiolysis has been performed since air leak is more efficiently drained by a conventional chest tube with underwater seal. After confirming lungs expansion, ribs are approximated with suture. Muscle and skin are closed in layers.

Fig. 11.2Left recurrent laryngeal nerve lymphadenectomy . E Esophagus (retracted posteriorly), T Trachea (retracted anteriorly), L Left lung. White arrow: left recurrent laryngeal nerve (after lymphadenectomy). The integrity of the left recurrent laryngeal nerve is checked by the ball-tip intermittent nerve stimulator

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