Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection

Hikage, Makoto; Kamei, Takashi; Nakano, Toru; Abe, S.; Katsura, Koji; Taniyama, Yusuke; Sakurai, Tadashi; Teshima, Jin; Ito, Soichi; Niizuma, Nobuchika; Okamoto, Hiroshi; Fukutomi, Toshiaki; Yamada, Masato; Maruyama, Shota; Ohuchi, Noriaki

doi:10.1007/s00464-016-5317-8

Cited by 45 publications

(39 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Noninvasive intraoperative neurological monitoring (IONM) may enable surgeons to identify and preserve the RLN. IONM is already widely used in thyroid surgery, and although its effectiveness for esophagectomy is not well recognized, several studies report lower RLNP and consequently lower pulmonary complication rates (8,20,(36)(37)(38). Therefore, the use of IONM may be considered for esophagectomy, particularly during high mediastinal lymph node dissection (10).…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes

Scholtemeijer¹,

Seesing²,

Brenkman³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes

Scholtemeijer¹,

Seesing²,

Brenkman³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Recently, there have also been other occasional reports of intraoperative monitoring of the RLN during esophageal cancer surgery [14,15]. The significance of performing intraoperative nerve monitoring routinely for the purpose of preventing RLN paralysis needs to be carefully examined further, although intraoperative nerve monitoring certainly appears to be useful in cases with anatomical abnormalities of the RLN, as in this case.…”

Section: Discussionmentioning

confidence: 88%

Thoracoscopic esophagectomy with left recurrent laryngeal nerve monitoring for thoracic esophageal cancer in a patient with a right aortic arch: a case report

et al. 2020

View full text Add to dashboard Cite

Background: Surgery for cases of thoracic esophageal cancer with a right aortic arch is rare, and the anatomic abnormalities in such patients necessitate a different surgical approach. Since the position of the recurrent laryngeal nerve often differs from the usual in these cases, the lymph node dissection around the recurrent laryngeal nerve, which is an important step in surgery for thoracic esophageal cancer, requires careful attention. There are some reports on the usefulness of intraoperative recurrent laryngeal nerve monitoring during esophageal cancer surgery. Herein, we report a case of successful thoracoscopic esophagectomy for esophageal cancer in a patient with a right aortic arch using intraoperative recurrent laryngeal nerve monitoring. Case presentation: A 70-year-old man was diagnosed as having esophageal cancer (Ut, type 0-IIc, T1b/MtLt, type 0-IIc, T1b, N2, M0, cStage II) and was treated by neoadjuvant chemoradiotherapy followed by radical surgery. Preoperative CT examination revealed a right aortic arch, and based on the findings of 3D-CT, we classified the right aortic arch as type IIIB1 (Edwards classification), which is the most frequent type of right aortic arch. We performed thoracoscopic esophagectomy via a left thoracic approach with the patient placed in the prone position, cervical esophagogastric conduit reconstruction via the retrosternal route, and three-field lymph node dissection. Although Kommerell's diverticulum could be easily confirmed, the descending aorta took a meandering course, making it difficult for the esophagus to be mobilized and detached and therefore also to identify the ductus arteriosus and left recurrent laryngeal nerve. Intraoperative recurrent laryngeal nerve monitoring using NIM-RESPONSE® 3.0 (Medtronic Japan, Tokyo, Japan) allowed the position of the left recurrent laryngeal nerve to be accurately determined, and upper mediastinal lymph node dissection and mobilization of the upper thoracic esophagus were performed safely. Postoperatively, the patient showed no evidence of recurrent laryngeal nerve palsy, but needed conservative treatment for anastomotic leakage. The patient was discharged 46 days after the surgery.(Continued on next page)

show abstract

“…Patients with respiratory comorbidities or decreasing preoperative respiratory function may not always develop postoperative pulmonary complications. Practically, jejunostomy should be performed for elderly patients with reduced function of swallowing preoperatively and for patients with intraoperatively confirmed bilateral vocal code palsy or depressed bloodstream of conduit (31,32). If complications arise after esophagectomy, nasojejunal tube can be selected.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy

Akiyama¹,

Iwaya²,

Endo³

et al. 2018

J. Thorac. Dis

View full text Add to dashboard Cite

Background: Previous studies have shown that enteral nutrition (EN) helps reduce severe postoperative complications after esophagectomy. However, the incidence of jejunostomy-related complications is approximately 30%. We evaluated the operative outcomes in patients who did not receive EN via feeding jejunostomy after esophagectomy. Methods: We retrospectively reviewed 76 consecutive patients with esophageal cancer who received radical esophagectomy. Operative outcomes were compared between 33 patients who received postoperative EN via feeding jejunostomy (group A; from May 2014 to September 2015) and 43 patients who did not receive EN via feeding jejunostomy (group B; from September 2015 to December 2017). Results: The American Society of Anesthesiologists performance status score of the patients in group B was significantly higher than that of patients in group A (P=0.002). The postoperative morbidity rate was comparable between the two groups (group A, 30.3% vs. group B, 44.2%, P=0.217). No significant betweengroup differences were observed in the incidence of infectious complications, postoperative hospital stay, readmission within 30 days after discharge, or pneumonia after discharge within 6 months. The incidence of bowel obstruction was significantly higher in group A than in group B (group A, 9.1% vs. group B, 0%, P=0.044). Two patients in group B required nutritional support via total parenteral nutrition due to bilateral vocal cord palsy or pneumonia. Conclusions: Jejunostomy-related bowel obstruction in the patients with feeding jejunostomy was significantly higher than that in the patients without jejunostomy. There was no increase in postoperative complications (including pneumonia) in the patients who did not receive EN via feeding jejunostomy. Our results suggest that routine feeding jejunostomy may not be necessary for all patients undergoing esophagectomy.

show abstract

Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection

Abstract: This study confirmed the feasibility and safety of IONM of the RLN for thoracoscopic esophagectomy in the prone position. No significant differences in postoperative outcomes were seen between esophagectomy with and without IONM.

Cited by 45 publications

References 30 publications

Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes

Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes

Thoracoscopic esophagectomy with left recurrent laryngeal nerve monitoring for thoracic esophageal cancer in a patient with a right aortic arch: a case report

Evaluation of the need for routine feeding jejunostomy for enteral nutrition after esophagectomy

Contact Info

Product

Resources

About