Back to ISMICS Main Site
 


Quick Links
   Home
Loading

 



Back to Thoracic Track Day Program


Cases of Chylothorax and Recurrent Laryngeal Nerve Injury Associated with Mediastinal Lymph Node Dissection During Robotic Video Assisted Thoracoscopic Lung Resection
Inderpal S. Sarkaria, David J. Finley, Manjit S. Bains, Prasad S. Adusumilli, Nabil P. Rizk, James Huang, Robert Downey, Valerie W. Rusch, David R. Jones.
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

OBJECTIVE: Robotic Video Assisted Thoracic Surgery (RVATS) is increasing for lung resections. While improved visualization and instrument dexterity are potentially advantageous compared to standard thoracoscopy, our initial experience suggests complications associated with systematic lymph node dissection during these procedures, specifically recurrent laryngeal nerve injury (RLNI) and chylothorax, may be significant.
METHODS: Consecutive patients undergoing RVATS anatomic lung resections for suspected or confirmed cancer performed during the study period and with a complication of RLNI or chylothorax were identified and reviewed from a prospectively maintained database. Complications were graded according to the Common Terminology Criteria for Adverse Events v. 3.0 (CTCAE).
RESULTS: From July 28, 2010 to December 20, 2013, 251 patients underwent RVATS segmentectomy, lobectomy, or bilobectomy with MLND. 11 patients (4.4%) experienced MLND related complications and comprised the study group. There were 6 cases (2.4%) of RLNI and 6 cases (2.4%) of chylothorax. Case-specific data are presented in Table I. The majority of cases (81.8%) were right sided resections, and median lymph node counts in right station IV and station VII were 9 (range 1-23) and 5.5 (1-10), respectively. 74.5% of cases were performed for early stage I and II lung cancers. Complications requiring procedural intervention (Grade 3) included 4 cases of RLNI undergoing percutaneous vocal cord medialization and 3 cases of chylothorax undergoing image guided thoracic duct embolization or maceration. No operative interventions were required and there was no operative mortality.
CONCLUSIONS: Chylothorax and RLNI are rare complications with reported occurrence rates of 1.7% and 1.0%, respectively, after systematic MLND during open or VATS pulmonary resections.1 RVATS MLND during anatomic lung resections may be associated with increased rates of chylothorax and RLNI, notwithstanding improved magnification and dexterity. Further prospective studies are warranted to understand potential technical advantages and pitfalls of RVATS MLND and allow adjustment of surgical technique accordingly.
1. Allen MS et al. Ann Thorac Surg. 2006 Mar;81(3):1013-9
Data summary of patients with RVATS MLND associated complications.
Case#Complications(s)Procedure LateralityMLND Station(s)LN Count(s)OperationStageCTCAE
1
2
3
L RLN
L RLN
Chylothorax
Right
Left
Left
IV, VII
V, VII
V, VII
NR, 6
2, 8
2, 5
Bilobectomy
Lobectomy
Lobectomy
IIIA
IA
IV
3
3
3
4R RLNRightIV, VII9, 4SegmentectomyIA1
5ChylothoraxRightIV, VII1, 1LobectomyIB2
6ChylothoraxRightVII9LobectomyBenign2
7ChylothoraxRightVIINRLobectomyIA3
8RLNRightIV, VII7, NRLobectomyIB1
9R RLNRightIV, VII23, 3BilobectomyIA3
10R RLN
Chylothorax
RightIV, VII19, 10LobectomyIIA3
11ChylothoraxRightIV, VIINR, NRLobectomyIIA3


Back to Thoracic Track Day Program
 
© 2024 International Society for Minimally Invasive Cardiothoracic Surgery. All Rights Reserved. Read Privacy Policy.