Efficacy of intraoperative recurrent laryngeal neuromonitoring during surgery for esophageal cancer

Abstract

Aim To evaluate the efficacy of intraoperative neuromonitoring in identifying recurrent laryngeal nerves and decreasing the incidence of nerve injury in minimally invasive esophagectomies for esophageal cancers. Methods A total of 167 minimally invasive esophagectomy patients were retrospectively reviewed. They were divided into intraoperative neuromonitoring (n = 84) and no intraoperative neuromonitoring (n = 83) groups, based on whether or not intraoperative neuromonitoring was used during surgery. We compared short‐term surgical outcomes and incidence of recurrent laryngeal nerve palsy between the two groups before and after propensity score matching. The association between the loss of signal and recurrent laryngeal nerve palsy was also evaluated. Results The incidence of recurrent laryngeal nerve palsy (grade 2 and higher) was lower in the intraoperative neuromonitoring group than in the no intraoperative neuromonitoring group (6.0% vs 21.2%, P = 0.02). The rate of recurrent laryngeal nerve palsy recovery within 6 months was also significantly higher in the intraoperative neuromonitoring group (87.5% vs 20.0%, P < 0.01). The positive and negative predictive values of intraoperative neuromonitoring for recurrent laryngeal nerve palsy were 60% (9/15) and 86.9% (60/69), respectively. The duration from paralysis to recovery was shorter in recurrent laryngeal nerve palsy cases with negative loss of signal results than in cases with positive loss of signal results (median: 43 days vs 95 days). Conclusion Intraoperative neuromonitoring is useful in identifying recurrent laryngeal nerves and may aid in reducing the incidence of recurrent laryngeal nerve injury during esophageal surgery.

Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis

“…Additionally, four meeting abstracts lacking full texts (41)(42)(43)(44), two studies which utilized data from the same study (45,46), and two studies which were not in English (47,48) were excluded. Finally, a total of five studies, including three retrospective cohort studies and two prospective cohort studies, comprising a total of 509 patients undergoing thoracoscopic esophagectomy for esophageal cancer were identified (16)(17)(18)(19)(20). In total, there were 240 and 269 patients who underwent surgery with and without IONM, respectively.…”

“…Intra-operative nerve monitoring (IONM), which can identify nerves and is widely utilized in thyroid surgery, has been demonstrated as a good approach for protecting RLN (12)(13)(14)(15). Recent studies examining the utility of IONM in esophagectomy reported its feasibility and efficacy in protecting the RLN (16)(17)(18)(19)(20). However, studies focusing on the utility of IONM as a method are limited and the number of patients included in these studies remains low.…”

Clinical Outcome of Intraoperative Recurrent Laryngeal Nerve Monitoring during Thoracoscopic Esophagectomy and Mediastinal Lymph Node Dissection for Esophageal Cancer

“…The protective effects of IONM during esophagectomy were diversely reported in previous studies [ 18 , 19 , 20 ]. Our study revealed a significant benefit of IONM on postoperative vocal cord palsy and pneumonia, as well as the relationship between IONM, vocal palsy, and mortality, wherein IONM may relate to prolonged 2-year survival after thoracoscopic esophagectomy for esophageal cancer.…”

“…Postoperative RLN palsy, aspiration, and pneumonia were similar in both groups. Takeda et al revealed that IONM could decrease grade II or more RLN palsy but without difference in terms of pneumonia, anastomotic leakage, and other complications [ 20 ]. Our study revealed that all patients in the IONM group could complete the IONM with a positive signal before and after dissection.…”

Risk factors and a nomogram model for postoperative delirium in elderly gastric cancer patients after laparoscopic gastrectomy

“…Surgical resection is the primary curative therapeutic strategy for GC. Postoperative complications after GC surgery are known to have serious effects on patient prognosis and quality of life [ 5 , 6 ]. Postoperative delirium (POD) is a very common and serious complication, especially in elderly hospitalized patients [ 7 ].…”