ObjectiveTo summarize the complications after supraclavicular lymph node dissection for invasive breast cancer patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis, and to analyze its safty. MethodsA retrospectively clinical analysis of the complications of 98 invasive breast cancer patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis, who underwent supraclavicular lymph node dissection in our hospital from Jan. 2014 to Dec. 2015 was performed. ResultsThere were 20 cases of lymphedema (20.4%, 20/98), 4 cases of hypaesthesia (4.1%, 4/98), and 4 cases of abduction restriction of shoulder joint (4.1%, 4/98). No other serious complications occurred. There was no shape change of shoulder and upper arm abduction, facial edema, head and neck disorders, pleural effusion or chylothorax happened. The extubation time of drainage tube at axillary and chest wall in 78 cases was in 1 month after the operation, 18 cases was in 1-2 months, and 2 cases was in 2-3 months. There were 14 cases (14.3%) suffered from the ipsilateral axillary or pleural effusion after extubation. The extubation time of supraclavicular drainage tube in 98 cases was 3-7 days after the surgery, with the median of 4.5 days, including 3 cases (3.1%) of chyle leakage. ConclusionThe supraclavicular lymph node dissection has no serious postoperative complications, and is safe to patients with ipsilateral supraclavicular lymph node metastasis but without distant metastasis.
ObjectiveTo investigate the predictive value of recurrent laryngeal nerve lymph nodes (RLN) status for supraclavicular lymph node (SLN) metastasis in esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital, including 53 males and 30 females with an average age of 64.07±7.05 years.ResultsThe SLN metastasis rate of the patients was 24.1%. The rate in the thoracic and abdominal metastases positive (N1-3) group and negative (N0) group was 37.8% and 13.0%, respectively, with a statistical difference (P<0.05). The rate of SLN metastasis was significantly different between the RLN metastasis positive (RLN+) and negative (RLN–) groups (39.1% vs. 18.3%, P<0.05). One side of RLN metastasis could lead to SLN metastasis on the opposite side. No correlation between the SLN metastasis and age, gender, location, differentiation degree, maximum tumor diameter, T-staging or histologic type was observed (P>0.05). Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.ConclusionRLN+ is not the independent predictor for SLN metastasis. SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging. Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.
Objective To review the research progress of supraclavicular vascularized lymph node transfer (VLNT). Methods The research literature related to supraclavicular VLNT at home and abroad in recent years was extensively reviewed, and the anatomy of supraclavicular lymph nodes, clinical applications, and complications of supraclavicular VLNT were summarized. Results The supraclavicular lymph nodes are anatomically constant, located in the posterior cervical triangle zone, and the blood supply comes mainly from the transverse cervical artery. There are individual differences in the number of supraclavicular lymph nodes, and preoperative ultrasonography is helpful to clarify the number of lymph nodes. Clinical studies have shown that supraclavicular VLNT can relieve limb swelling, reduce the incidence of infection, and improve quality of life in patients with lymphedema. And the effectiveness of supraclavicular VLNT can be improved by combined with lymphovenous anastomosis, resection procedures, and liposuction. ConclusionThere are a large number of supraclavicular lymph nodes, with abundant blood supply. It has been proven to be effective for any period of lymphedema, and the combined treatment is more effective. The more clinical studies are needed to clarify the effectiveness of supraclavicular VLNT alone or in combination, as well as the surgical approach and timing of the combined treatment.