Abstract
Background
The problem of recurrent laryngeal nerve (RLN) paralysis (RLNP) after radical esophagectomy remains unresolved. Several studies have confirmed that intraoperative nerve monitoring (IONM) of the RLN during thyroid surgery substantially decreases the incidence of RLN damage. This study tried to determine the feasibility and effectiveness of IONM of the RLN during thoracoscopic esophagectomy in the prone position for esophageal cancer.
Methods
All 108 patients who underwent prone esophagectomy at Tohoku University Hospital between July 2012 and March 2015 were included in this study. We divided patients into two groups: a control group (No-Monitoring group, surgery without IONM; n = 54) and a study group (Monitoring group, surgery with IONM; n = 54). In Monitoring group, neural stimulation was performed for both RLNs before and after dissection in the thoracic procedure, then for RLNs and vagus nerves (VNs) in the cervical procedure. The feasibility of IONM in Monitoring group and early surgical outcomes were retrospectively compared with those in No-Monitoring group.
Results
IONM could be performed for 47 cases (87.0%) in Monitoring group. Reasons for discontinuation were use of muscle relaxants (3 patients), change in thoracotomy procedure (2 patients), past rib bone fracture (1 patient), and allergic shock by transfusion (1 patient). Right RLNPs were identified postoperatively in 4 patients, and left RLNPs in 23 patients. IONM sensitivities were 92.7 and 88.0% for the right and left VNs, respectively. Incidences of postoperative RLNP, aspiration, and primary pneumonia did not differ significantly between groups.
Conclusions
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.
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Acknowledgements
We thank T. Nakagawa, K. Takaya, C. Sato, and K. Kamiya for helpful discussion, Prof. M. Yamauchi for technical guidance, and M. Tokunaga for help with paper organization. This work was supported by Grants-in-Aid for Scientific Research in Priority Areas from the Japan MEXT (T. Nakano and N. Ohuchi).
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Drs. Makoto Hikage, Takashi Kamei, Toru Nakano, Shigeo Abe, Kazunori Katsura, Yusuke Taniyama, Tadashi Sakurai, Jin Teshima, Soichi Ito, Nobuchika Niizuma, Hiroshi Okamoto, Toshiaki Fukutomi, Masato Yamada, Shota Maruyama, and Noriaki Ohuchi have no conflicts of interest or financial ties to disclose.
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Hikage, M., Kamei, T., Nakano, T. et al. Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection. Surg Endosc 31, 2986–2996 (2017). https://doi.org/10.1007/s00464-016-5317-8
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DOI: https://doi.org/10.1007/s00464-016-5317-8