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Intraoperative nerve monitoring during esophagectomy reduces the risk of recurrent laryngeal nerve palsy

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Abstract

Background

Despite the risk of recurrent laryngeal nerve (RLN) palsy during esophagectomy, no established method of monitoring RLN injury is currently available.

Methods

This study included 187 patients who underwent esophagectomy between 2011 and 2018. Among these, intraoperative nerve monitoring (IONM) was done in 142 patients (IONM group), while the remaining 45 patients underwent conventional surgery without IONM (control group). We investigated the incidence of postoperative complications with regard to the use of IONM.

Results

The overall incidence of postoperative RLN palsy was 28% (52/187). The IONM group showed a significantly lower incidence of postoperative RLN palsy as compared to that in the control group (p = 0.004). The overall incidence of postoperative pneumonia was 22% (41/187) in those with Clavien–Dindo (CD) classification beyond grade 2. There were no significant differences between the incidence of any grade of postoperative pneumonia and the use of IONM (p = 0.195 and 0.333; CD > 2 and > 3, respectively). Multivariate analysis demonstrated that tumors in the upper third [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.04–9.29] and lack of IONM use (OR 2.51; 95% CI 1.17–5.38) were independent factors causing postoperative RLN palsy after esophagectomy.

Conclusion

IONM helps to reduce the risk of postoperative RLN palsy after esophageal cancer surgery.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa-shi, Chiba, 277-8567, Japan

    Masami Yuda

  2. Department of Gastroenterological Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Katsunori Nishikawa, Yoshitaka Ishikawa, Keita Takahashi, Takanori Kurogochi, Yujiro Tanaka, Akira Matsumoto, Yuichiro Tanishima, Norio Mitsumori & Toru Ikegami

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  1. Masami Yuda
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  2. Katsunori Nishikawa
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Correspondence to Masami Yuda.

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Drs. Masami Yuda, Katsunori Nishikawa, Yoshitaka Ishikawa, Keita Takahashi, Takanori Kurogochi, Yujiro Tanaka, Akira Matsumoto, Yuichiro Tanishima, Norio Mitsumori, and Toru Ikegami have no conflicts of interest or financial ties to disclose.

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Yuda, M., Nishikawa, K., Ishikawa, Y. et al. Intraoperative nerve monitoring during esophagectomy reduces the risk of recurrent laryngeal nerve palsy. Surg Endosc 36, 3957–3964 (2022). https://doi.org/10.1007/s00464-021-08716-3

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