Several authors have reported on the left trans-cervical and transhiatal approaches under pneumomediastinum and right cervical open surgery for mediastinoscopic esophagectomy. However, with these approaches, sufficient dissection of the right upper mediastinal paraesophageal lymph nodes, right recurrent nerve lymph nodes and the subaortic arch to the left tracheobronchial lymph nodes is thought to be difficult. We herein report the usefulness of the ‘bilateral’ trans-cervical pneumomediastinal approach. Methods Ten patients with thoracic esophageal cancer were treated using this approach. Under pneumomediastinum via a right neck incision, the right cervical and upper mediastinal paraesophageal lymph nodes were dissected. The left recurrent nerve lymph nodes were dissected using a left trans-cervical pneumomediastinal approach. The subaortic arch to the left tracheobronchial lymph nodes was dissected with a combined right and left trans-cervical crossover approach. After this approach, thoracoscopic observation was then performed in the left decubitus position, and if the lymph nodes were not sufficiently dissected, the remnant lymph nodes were retrieved thoracoscopically. Results The average total number of dissected lymph nodes among the right cervical and upper mediastinal paraesophageal lymph nodes identified with a right cervical open/right trans-cervical mediastinoscopic/right thoracoscopic approach was 3.2/4.0/0.6, respectively. The average total number of dissected lymph nodes among the subaortic arch to the left tracheobronchial lymph nodes with a right trans-cervical mediastinoscopic/right thoracoscopic approach was 1.5/0.6, respectively. These findings indicate that, without the right trans-cervical pneumomediastinal approach, roughly four of the right cervical and upper mediastinal paraesophageal lymph nodes and one or two of the subaortic arch to the left tracheobronchial lymph nodes could not have been retrieved. Conclusion A bilateral trans-cervical pneumomediastinal approach is useful for achieving sufficient upper mediastinal lymph node dissection and esophagectomy.

中文翻译：

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190 双侧经颈肺和纵隔入路对纵隔镜根治性食管切除术的有用性

有几位作者报道了纵隔气肿下的左侧经颈和经裂孔入路以及纵隔镜食管切除术的右侧颈椎开放手术。然而，使用这些方法，右上纵隔食管旁淋巴结、右返神经淋巴结和主动脉下弓至左气管支气管淋巴结的充分解剖被认为是困难的。我们在此报告“双侧”经颈肺纵隔入路的有用性。方法采用该方法治疗10例胸段食管癌患者。经右颈切口在纵隔积气下，解剖右颈和上纵隔食管旁淋巴结。使用左侧经颈肺纵隔入路解剖左侧神经回流淋巴结。左气管支气管淋巴结的主动脉弓下弓采用左、右联合经颈交叉方法解剖。经此入路后，在左侧卧位进行胸腔镜观察，若淋巴结清扫不充分，则经胸腔镜取回残余淋巴结。结果右颈开路/右经颈纵隔镜/右胸腔镜入路确定的右颈和上纵隔食管旁淋巴结平均切除淋巴结总数分别为3.2/4.0/0.6。右侧经颈纵隔镜/右侧胸腔镜入路从主动脉下弓到左侧气管支气管淋巴结的平均解剖淋巴结总数分别为1.5/0.6。这些发现表明，如果没有右侧经颈肺纵隔入路，大约 4 个右颈和上纵隔食管旁淋巴结和 1 个或 2 个主动脉下弓至左侧气管支气管淋巴结无法取出。结论双侧经颈肺纵隔入路有利于获得足够的上纵隔淋巴结清扫和食管切除术。