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Usefulness of intraoperative nerve monitoring in esophageal cancer surgery in predicting recurrent laryngeal nerve palsy and its severity

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Abstract

Background

Recurrent laryngeal nerve (RLN) palsy is a critical postoperative complication in esophageal cancer surgery. However, intraoperative prediction of its occurrence and severity is difficult. In this prospective study, we evaluated the usefulness of intraoperative nerve monitoring (IONM) in predicting RLN palsy and its severity.

Methods

Twenty patients who underwent subtotal esophagectomy with 3-field lymph node dissection were enrolled. Intraoperative electromyography (EMG) amplitudes of the vocal cords were measured by IONM at RLN and vagus nerve (VN) stimulation. Comparison was made between the vocal cords with RLN palsy and those without palsy and additionally between the vocal cords with transient RLN palsy and those with persistent palsy.

Results

Among 40 vocal cords in 20 patients, 26 were intact and 14 were paralyzed. Seven had transient, six had permanent palsy. The mean EMG amplitude of intact vocal cords was significantly larger than that of paralyzed ones at VN (506 ± 498 µV vs. 258 ± 226 µV, p = 0.022) and RLN stimulation (642 ± 530 µV vs. 400 ± 308 µV, p = 0.038). The cut-off value for postoperative palsy were 419 µV [positive predictive value (PPV): 48.0%, negative predictive value (NPV): 84.6%] at VN and 673 µV (PPV: 44.8%, NPV: 90.9%) at RLN stimulation. The mean EMG amplitude of persistently paralyzed vocal cords tended to be small, compared with that of recovered ones at both VN (168 ± 173 µV vs. 336 ± 266 µV, p = 0.11) and RLN (244 ± 223 µV vs. 536 ± 344 µV, p = 0.051) stimulation.

Conclusion

The absolute EMG amplitude of IONM might be helpful to predict the occurrence and severity of RLN palsy after esophageal surgery although the predictive value is low.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Takashi Kanemura, Hiroshi Miyata, Makoto Yamasaki, Tomoki Makino, Yasuhiro Miyazaki, Tsuyoshi Takahashi, Yukinori Kurokawa, Masaki Mori & Yuichiro Doki

  2. Department of Gastroenterological Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Chuou-ku, Osaka, 541-8567, Japan

    Hiroshi Miyata

  3. Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya City University, 1 Kawasumi, Mizuho, Nagoya, 467-8601, Japan

    Shuji Takiguchi

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  1. Takashi Kanemura
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  2. Hiroshi Miyata
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  3. Makoto Yamasaki
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  4. Tomoki Makino
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  5. Yasuhiro Miyazaki
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Correspondence to Hiroshi Miyata.

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Kanemura, T., Miyata, H., Yamasaki, M. et al. Usefulness of intraoperative nerve monitoring in esophageal cancer surgery in predicting recurrent laryngeal nerve palsy and its severity. Gen Thorac Cardiovasc Surg 67, 1075–1080 (2019). https://doi.org/10.1007/s11748-019-01107-5

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  • DOI: https://doi.org/10.1007/s11748-019-01107-5

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