Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma

Sato, Yu; Kosugi, Shin‐ichi; Aizawa, Naotaka; Ishikawa, Takashi; Kano, Yosuke; Ichikawa, Hiroshi; Hanyu, Takaaki; Hirashima, Kotaro; Bamba, Takeo; Wakai, Toshifumi

doi:10.1007/s00268-015-3261-8

Cited by 86 publications

(61 citation statements)

References 39 publications

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“…Patients with RLNP may present with symptoms ranging from hoarseness, dyspnea during speech, aspiration, difficulty with coughing, marked morbidity through pulmonary complications [pneumonia, acute respiratory distress syndrome (ARDS), atelectasis], and may even suffocate in case of bilateral damage. Only few retrospective studies have reported on the consequences of RLNP on the short term, particularly the incidence of pulmonary complications (8)(9)(10)19,23,24). Furthermore, information on the long term (i.e., recovery and possible surgical interventions) is lacking.…”

Section: Introductionmentioning

confidence: 99%

“…For 6/21 of these patients surgical intervention (medialization thyroplasty) was required. All treatment interventions for vocal cord paralysis were conducted after a median time of 16.5 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] months after esophagectomy. Of all patients that underwent medialization thyreoplasty, 3/6 had no more RLNP symptoms afterwards 2/6 made a partial recovery from their RLNP, and 1/6 did not recover.…”

Section: Functional Outcomesmentioning

confidence: 99%

“…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%

See 2 more Smart Citations

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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Section: Introductionmentioning

confidence: 99%

Section: Functional Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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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“…Thus using hoarseness alone to diagnose RLN palsy will underestimate this complication. A review of three-field lymphadenectomy in Japan yielded an overall RLN palsy rate of 27% (20), some studies have shown up to 60% (1,21). In a recent detailed study on 299 patients, 60% developed RLN palsy, bilateral in 33%, right RLN in 8% and left in 59%.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the propensity of nodal spread along the recurrent laryngeal nerves (RLN), bilateral RLN nodal dissection is an important component of the operation. The RLN's are at risk of injury and the incidence of vocal cord paralysis after esophagectomy can be as high as 60% to 70% (1,2). In thyroidectomy, monitoring of RLN may reduce the chance of nerve injury.…”

Section: Introductionmentioning

confidence: 99%

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Wong¹,

Tong²,

Tsang³

et al. 2017

J. Vis. Surg

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For squamous cell carcinoma of the esophagus, extended mediastinal lymphadenectomy especially around the bilateral recurrent laryngeal nerves (RLN) is associated with high risk of nerve injury.This does not only result in hoarseness of voice, increase the chance of pulmonary complications, but would also affect the quality of life of patients in the long term. Methods to improve safety of lymphadenectomy are desirable. Continuous intraoperative nerve monitoring (CIONM) based on a system using vagus nerve stimulation was tested. In thyroidectomy, this system has been shown to be useful. Our patient cohort was when the electrical signal is picked by an electrode on the endotracheal tune. It detects the amplitude of the electromyography (EMG) of the vocalis muscle as well as its latency of nerve conduction. Reduction in amplitude and increase in latency of the laryngeal EMG signifies imminent injury to the RLN. In thyroidectomy, this system has been shown to be useful (3,4). We describe the adaptation of a commercially available continuous nerve monitoring equipment-NIM 3.0 with APS (Medtronic Inc., Jacksonville, FL, USA) for use in video-assisted thoracoscopic (VATS) minimally invasive esophagectomy (MIE). A pilot study of ten patients has been published recently (5). Patient selection and workupExtended lymphadenectomy is associated with increased morbidity; many surgeons would be selective in its application only in good risk patients. After neoadjuvant chemoradiotherapy, many would also shy away from RLN dissection, especially in the context of VATS esophagectomy. Radiotherapy may result in more fibrosis with obscured tissue planes and it is hard to differentiate cancer infiltration from post radiation fibrosis. In other cases, the tissue may actually become more edematous, easing dissection (6). In the TIME (Traditional Invasive vs. MIE) trial, the primary end-point is difference in pulmonary infection rates between open and MIE. The pulmonary complication rate and the RLN palsy rate were lower in the minimally invasive group while other complications and mortality rates were not significantly different. Bilateral RLN nodal dissection however was not routinely performed (7). Our patients were unselected; the intent was to perform bilateral RLN dissection in a consecutive group of patients. All patients had VATS esophagectomy and 52.5% had had prior chemoradiotherapy. Given the patient population, a higher RLN injury rate may be expected. The incidence of right RLN injury was expectedly to be low, since the nerve is more constant in its position and the area that requires dissection is small. But for the left side, after chemoradiation nearly twice the rate of nerve palsy was found compared to those who had not although the numbers were still small to make this statistically significant. It is the author's experience that after chemoradiation to the superior mediastinum, dissection in the left paratracheal area is more difficult. To strike a balance between striving for cure and increased morbidity, i...

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Prevalence and resource utilization for vocal fold paralysis/paresis after esophagectomy

et al. 2018

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Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma

Abstract: RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62% of affected nerves recovered within 12 months, great attention should be given when performing these procedures.

Cited by 86 publications

References 39 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

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Prevalence and resource utilization for vocal fold paralysis/paresis after esophagectomy

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