1．胸腔鏡下食道癌手術における縦隔リンパ節郭清

Thoracoscopic Esophagectomy with Mediastinal Lymphadenectomy in Prone Position

本邦における食道癌の手術治療は，1990年代の検証により，頸部，胸部，腹部の3領域郭清が標準となった．特に，頸胸境界部や上縦隔リンパ節はその転移頻度の高さと郭清効果からもっとも重要な郭清部位といえる1）．

Recently, thoracoscopic esophagectomy has been widely accepted as a minimally invasive surgery and a possible standard procedure for esophageal cancer patients. Furthermore, it has an advantage for meticulous lymph node dissection by providing a magnification view and less blood loss. Mediastinal lymphadenectomy, especially upper mediastinal lymph node dissection, is a key point for esophageal cancer surgery because of its high frequency of metastasis and dissection efficacy. To avoid complications such as recurrent laryngeal nerve palsy, pneumoniae, chylothorax and unexpected injury in mediastinal lymph node dissection, detailed anatomical knowledge and careful procedures are required for surgeon. An appropriate operative procedure or technique will lead to good short- and long-term outcomes for the patients with esophageal cancer.