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

Abstract

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.

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

“…These findings were confirmed in more recent studies, all demonstrating an increase in pulmonary complications after esophagectomy complicated by RLNP (9,10,20,24). Similarly to our results, Koyanagi et al (10) found an association between RLNP and prolonged hospital stay.…”

“…The results of this study regarding short-term complications after RLN injury during esophagectomy are in line with current literature (9,10,20,23,24). The first study published on this topic found higher rates of pulmonary complications after RLNP, leading to a higher reintubation rate, and consequently a prolonged ventilation time and longer ICU stay (23).…”

“…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).…”

“…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.…”

Expression of TGF-<i>β</i>1 and CTGF Is Associated with Fibrosis of Denervated Sternocleidomastoid Muscles in Mice

“…Surgical or traumatic disruption of the recurrent laryngeal nerve may cause a series of issues, such as unilateral vocal cord paralysis, leading to phonatory disorders, dyspnea, and aspiration, which greatly impair the quality of life (Koyanagi et al 2015). With the development of microsurgical techniques, considerable success has been achieved in restoring the physiological function of denervated laryngeal muscles by laryngeal reinnervation, thereby enhancing phonation and optimizing vocal quality (Zheng et al 1996;Donghui et al 2010;Li et al 2013Li et al , 2014.…”