Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer

Abstract

It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the incidence of recurrent laryngeal nerve paralysis after esophagectomy was sought. A total of 115 patients diagnosed with esophageal cancer were enrolled in the thoracic section of the Tangdu Hospital of the Fourth Military Medical University from April 2008 to April 2009. Clinical parameters of patients, the morbidity, and the mortality following esophageal resection were recorded and compared. After the surgery, a 2-year follow up was completed. It was found that recurrent laryngeal nerve paralysis and postoperative pneumonia were more frequently diagnosed in the patients that did not receive continuous recurrent laryngeal nerve monitoring (6/61 vs. 0/54). Furthermore, positive mediastinal lymph nodes (P = 0.015), total mediastinal lymph nodes (P < 0.001), positive total lymph nodes (P = 0.027), and total lymph nodes (P < 0.001) were more often surgically removed in the patients with continuous recurrent laryngeal nerve monitoring. These patients also had a higher 2-year survival rate (P = 0.038) after surgery. It was concluded that continuous intraoperative recurrent laryngeal nerve monitoring is technically safe and effectively identifies the recurrent laryngeal nerves. This may be a helpful method for decreasing the incidence of recurrent laryngeal nerve paralysis and postoperative pneumonia, and for improving the efficiency of lymphadenectomy.

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

“…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).…”

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

“…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.…”

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

“…At the same time less RLN paralysis and post-operative pneumonia were found. Conventional nerve monitoring technique without CIONM was used in the study (22). Having utilized this method, we feel that it will not be appropriate to conduct a study to compare nodal dissection with and without monitoring.…”