Abstract：
BACKGROUND: The optimal extent of lymph node dissection (LND) and the anatomic boundaries per lymph node station (LNS) during minimally invasive esophagectomy (MIE) for esophageal cancer remain a topic of debate. This study investigated the opinion of Dutch esophageal cancer surgeons on their routine LND extent and anatomic boundaries per LNS during MIE.
METHODS: In April 2023, an English web-based cross-sectional survey was conducted. In each of the 15 Dutch hospitals performing MIE, two MIE surgeons were asked to participate. The routine LND extent (quantity, specific LNS) for distal esophageal adenocarcinoma, (dis)agreement with the TIGER definition, and anatomic boundaries for each LNS in six directions were queried.
RESULTS: The survey was completed by 24 Dutch MIE surgeons (80% response rate). Consensus on the routine LND extent ( ≥ 85% of the participating surgeons) included the left and right paracardial, left gastric artery, celiac trunk, proximal splenic artery, common hepatic artery, subcarinal middle mediastinal paraoesophageal, lower mediastinal paraoesophageal, pulmonary ligament, and upper mediastinal paraoesophageal LNSs. Other LNSs were not widely considered routine. Although, certain anatomic boundaries were consistent among the surgeons, the majority varied, even when they agreed on the TIGER definition.
CONCLUSIONS: Significant variations in surgical practice among Dutch esophageal surgeons regarding their routine extent of LND and anatomic boundaries of LNSs during MIE were demonstrated. Variation may have an impact on clinical outcomes, hampering uniform treatment strategies and hindering comparison of performance assessments. This study highlighted the need for an international follow-up study toward one uniform defined LND during MIE for esophageal cancer.
METHODS: In April 2023, an English web-based cross-sectional survey was conducted. In each of the 15 Dutch hospitals performing MIE, two MIE surgeons were asked to participate. The routine LND extent (quantity, specific LNS) for distal esophageal adenocarcinoma, (dis)agreement with the TIGER definition, and anatomic boundaries for each LNS in six directions were queried.
RESULTS: The survey was completed by 24 Dutch MIE surgeons (80% response rate). Consensus on the routine LND extent ( ≥ 85% of the participating surgeons) included the left and right paracardial, left gastric artery, celiac trunk, proximal splenic artery, common hepatic artery, subcarinal middle mediastinal paraoesophageal, lower mediastinal paraoesophageal, pulmonary ligament, and upper mediastinal paraoesophageal LNSs. Other LNSs were not widely considered routine. Although, certain anatomic boundaries were consistent among the surgeons, the majority varied, even when they agreed on the TIGER definition.
CONCLUSIONS: Significant variations in surgical practice among Dutch esophageal surgeons regarding their routine extent of LND and anatomic boundaries of LNSs during MIE were demonstrated. Variation may have an impact on clinical outcomes, hampering uniform treatment strategies and hindering comparison of performance assessments. This study highlighted the need for an international follow-up study toward one uniform defined LND during MIE for esophageal cancer.
摘要：
背景：食管癌微创食管癌切除术（MIE）中淋巴结清扫（LND）的最佳范围和每个淋巴结位置（LNS）的解剖边界仍然是一个争论的话题。这项研究调查了荷兰食管癌外科医生对MIE期间常规LND范围和每个LNS的解剖边界的看法。
方法：2023年4月，进行了基于网络的英文横断面调查。在执行MIE的15家荷兰医院中，两名MIE外科医生被要求参加.常规LND范围(数量，特定的LNS）用于远端食管腺癌，(DIS)同意TIGER定义，并查询了六个方向上每个LNS的解剖边界。
结果：该调查由24名荷兰MIE外科医生完成（反应率为80％）。关于常规LND范围的共识(≥85%的参与外科医生)包括左心包和右心包,胃左动脉,腹腔后备箱,脾动脉近端,肝总动脉,隆突下中纵隔旁食管，下纵隔旁食管，肺韧带,和上纵隔旁食管LNS。其他LNS没有被广泛认为是常规的。虽然,外科医生的某些解剖边界是一致的，大多数不同，即使他们同意TIGER的定义。
结论：在MIE期间，荷兰食管外科医师在LND的常规范围和LNS的解剖边界方面在外科手术实践中存在显著差异。变异可能会对临床结果产生影响，阻碍统一的治疗策略，阻碍绩效评估的比较。这项研究强调了在食管癌MIE期间对一个统一定义的LND进行国际随访研究的必要性。
方法：2023年4月，进行了基于网络的英文横断面调查。在执行MIE的15家荷兰医院中，两名MIE外科医生被要求参加.常规LND范围(数量，特定的LNS）用于远端食管腺癌，(DIS)同意TIGER定义，并查询了六个方向上每个LNS的解剖边界。
结果：该调查由24名荷兰MIE外科医生完成（反应率为80％）。关于常规LND范围的共识(≥85%的参与外科医生)包括左心包和右心包,胃左动脉,腹腔后备箱,脾动脉近端,肝总动脉,隆突下中纵隔旁食管，下纵隔旁食管，肺韧带,和上纵隔旁食管LNS。其他LNS没有被广泛认为是常规的。虽然,外科医生的某些解剖边界是一致的，大多数不同，即使他们同意TIGER的定义。
结论：在MIE期间，荷兰食管外科医师在LND的常规范围和LNS的解剖边界方面在外科手术实践中存在显著差异。变异可能会对临床结果产生影响，阻碍统一的治疗策略，阻碍绩效评估的比较。这项研究强调了在食管癌MIE期间对一个统一定义的LND进行国际随访研究的必要性。
