Introduction:Identification of the thoracic duct (TD) is essential during esophageal surgery to reduce the risk of complications such as chylothorax. The clinical significance of the white plane, or Morosow’s ligament—a consistent anatomical landmark along the esophagus—remains poorly defined.Methods:A total of 166 patients undergoing robot-assisted minimally invasive esophagectomy (RAMIE) were analyzed. Intraoperative visualization of the white plane was documented. Patient demographics, tumor characteristics, postoperative complications, management strategies, hospital length of stay, and overall survival were assessed. Complication severity was graded using the Clavien–Dindo classification. The Kaplan–Meier and multivariable Cox regression analyses were used to evaluate prognostic factors, including BMI, ASA score, pneumonia, pT status, pN status, neoadjuvant and adjuvant therapy, and white plane visualization.Results:The white plane was visualized in 154 patients (92.8%). Postoperative complications, management strategies, hospital length of stay, and 30-/90-day in-hospital mortality did not differ between groups with visualized and not visualized white planes. Median overall survival was significantly longer in patients with a visible white plane (43.1 vs. 13.1 months;p= 0.0079). The multivariable analysis identified ASA classification, pT stage, pN stage, and adjuvant therapy as independent predictors of overall survival, whereas lymph node stage and adjuvant therapy were independent predictors of recurrence-free survival.Conclusions:The white plane is a distinct intraoperative anatomical structure that can be visualized in most RAMIE procedures. Its identification may assist in TD recognition and provides a framework for describing mediastinal anatomy, but further studies are needed to determine its impact on surgical standardization and patient outcomes.
引言：在食管手术中识别胸导管对于降低乳糜胸等并发症风险至关重要。白色平面（又称Morosow韧带）作为食管旁稳定的解剖学标志，其临床意义尚未明确。 方法：本研究纳入166例接受机器人辅助微创食管切除术的患者。术中记录白色平面的可视化情况，评估患者人口统计学特征、肿瘤特性、术后并发症、处理策略、住院时间及总生存期。并发症严重程度采用Clavien-Dindo分级系统进行分级。通过Kaplan-Meier法和多变量Cox回归分析评估预后因素，包括体重指数、ASA评分、肺炎、pT分期、pN分期、新辅助与辅助治疗及白色平面可视化情况。 结果：154例患者（92.8%）术中可见白色平面。白色平面可视化组与未可视化组在术后并发症、处理策略、住院时间及30天/90天院内死亡率方面均无显著差异。白色平面可视化患者的中位总生存期显著延长（43.1个月 vs 13.1个月，p=0.0079）。多变量分析显示ASA分级、pT分期、pN分期及辅助治疗是总生存期的独立预测因素，而淋巴结分期和辅助治疗是无复发生存期的独立预测因素。 结论：白色平面是机器人辅助微创食管切除术中可辨识的解剖结构，在多数手术中可实现可视化。该结构的识别可能有助于胸导管定位，并为描述纵隔解剖提供参考框架，但其对手术标准化及患者预后的影响仍需进一步研究验证。
The White Plane in Esophageal Surgery: A Novel Anatomical Landmark with Prognostic Significance
肿瘤(癌症)患者之家