Recurrent Laryngeal Nerve Monitoring During Esophagectomy and Mediastinal Lymph Node Dissection

Gelpke, Hans; Grieder, Felix; Decurtins, M; Cadosch, Dieter

doi:10.1007/s00268-010-0692-0

Cited by 57 publications

(66 citation statements)

References 18 publications

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“…Hence, complications and survival rates were compared between the dissection group and the control group. First, we knew that the major complications of RLN injury included hoarseness, anastomotic fistula and pulmonary complications from previous studies (17,21,22). The number of complications in the dissection group was greater than in the control group, and the differences were statistically significant ( Table 5).…”

Section: The Scoring Systemmentioning

confidence: 88%

“…Damage of RLNs includes resection, blood supply blockage for nerve nutrition, thermal damage, incorrect ligation, contusion and traction. The function of the vocal cords will recover in one year postoperatively, which depends on the extent of the laryngeal recurrent nerve injury (17). The diagnostic process for laryngeal recurrent nerve injury is based on a previous report (26).…”

Section: Discussionmentioning

confidence: 99%

“…Injury may generate hoarseness and breathy voice. The patient's cough is weak and pulmonary complications, including aspiration, may occur (17). Hence, surgical complications may be reduced for ESCC patients if unnecessary lymph node dissection is reduced.…”

Section: Original Articlementioning

confidence: 99%

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Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Lin

Chen

et al. 2016

J. Thorac. Dis.

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Background: Recurrent laryngeal nerve (RLN) injury is one of the most frequent postoperative complications of esophageal squamous cell carcinoma (ESCC) radical resection. This study aims to develop a novel scoring system to predict recurrent laryngeal nerve lymph node (RLNLN) metastases in early ESCC and explore the indications for precise RLN lymphadenectomy. Results: A total of 311 cases selected from 1,466 ESCC patients were divided into the dissection group and the control group. Age, tumor length, macroscopic tumor type, T stage, tumor location and tumor differentiation were independent predictors of RLNLN metastases. The weighted scoring system included age (+2 for <56 years), tumor length (+2 for over 4.45 cm), tumor location (+4 for upper thoracic, +2 for mid-thoracic) and macroscopic tumor type (+1 for advanced type). The total number of points estimated the probability of RLNLN metastases [low-risk (0-2 point), 0%; moderate-risk (3-4 points), 9.8%; and highrisk (>4 points), 43.4%]. Besides, the dissection group had more complications and similar survival rate when compared with the control group.Conclusions: We developed a novel scoring system that accurately estimated the risk of RLNLN metastases in early ESCC patients. RLN lymphadenectomy may be safely omitted for the patients in the low-risk subgroup.

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Section: The Scoring Systemmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Lin

Chen

et al. 2016

J. Thorac. Dis.

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“…Intraoperative RLN monitoring is widely used in thyroid and parathyroid surgery. This technique, which is based on an electrically stimulated response, has recently been adopted for intrathoracic surgeries, and several investigators have demonstrated the technical feasibility and clinical benefits for reducing the incidence of RLNP and postoperative pneumonia among patients undergoing transthoracic esophagectomy (Gelpke et al 2010;Zhong et al 2014). Surgeons usually use electrocautery for hemostasis.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

Koyanagi

Igaki

Iwabu

et al. 2015

Tohoku J. Exp. Med.

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Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy is a common complication and associated with aspiration pneumonia. In this study, we assessed the risk of RLNP and the usefulness of immediate reconstruction of recurrent laryngeal nerve (RLN) to prevent respiratory complications after esophagectomy. Seven hundred and eighty-two consecutive patients underwent an esophagectomy with three-field lymph node dissection, simultaneous gastric conduit reconstruction, and cervical anastomosis. Vocal cord function was observed using a flexible laryngoscope. Reconstruction between RLN and ipsilateral vagus nerve was performed during esophagectomy. RLNP was observed in 229 (29.3%) of the patients after esophagectomy: 198 unilateral and 31 bilateral cases. Of the 198 unilateral RLNP, vocal cord paralysis was observed predominantly on the left side (82.7%). RLNP was significantly associated with postoperative respiratory complications (P < 0.001) requiring a tracheotomy (P < 0.001) and mechanical ventilation (P < 0.001) and was also associated with esophagogastric anastomotic leakage (P = 0.015); consequently, the postoperative hospital stay was longer for patients with RLNP (P < 0.001). A longer operation time (P < 0.001) and advanced age (P = 0.038) were identified as significant independent predictors of RLNP. Resection of the RLN together with metastatic nodes was performed in 29 cases. The patients underwent RLN reconstruction (n = 11) had a significantly shorter postoperative hospital stay than those without RLN reconstruction (n = 18) (P = 0.019). In conclusion, RLNP was related to a poorer postoperative course among patients undergoing an esophagectomy. New surgical technologies are recommended for prevention of RLNP.

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“…The incidence of RLNP after esophagectomy varies, ranging from 0% to 59% (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). These disparities have been attributed to variation in extent of lymph node dissection, surgical technique (two-or three stage), the size and T-stage of the primary tumor, and the means of RLN injury diagnosis (8,(19)(20)(21).…”

Section: Introductionmentioning

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.

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Recurrent Laryngeal Nerve Monitoring During Esophagectomy and Mediastinal Lymph Node Dissection

Abstract: Intraoperative RLN identification and monitoring during single-lung ventilation surgery is technically feasible, easy, and reliable. The introduction of standardized RLN monitoring during this type of surgery may reduce the incidence of permanent RLN paralysis.

Cited by 57 publications

References 18 publications

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Recurrent laryngeal nerve lymph node dissection may not be suitable for all early stage esophageal squamous cell carcinoma patients: an 8-year experience

Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction

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

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