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Continuous Recurrent Laryngeal Nerve Monitoring During Single-Port Mediastinoscopic Radical Esophagectomy for Esophageal Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Although single-port mediastinoscopic radical esophagectomy is ultimate minimally invasive surgery for esophageal cancer without thoracotomy or the thoracoscopic approach, the high incidence of recurrent laryngeal nerve (RLN) palsy remains a pivotal clinical issue.

Methods

This study included 41 patients who underwent single-port mediastinoscopic radical esophagectomy with mediastinal lymphadenectomy between September 2014 and March 2022. Among these, continuous nerve monitoring (CNM) for RLN was done in 25 patients (CNM group), while the remaining 16 patients underwent without CNM (non-CNM group). Clinical benefits of CNM for RLN were evaluated.

Results

The overall incidence of postoperative RLN palsy was 14.6% (6/41). The CNM group showed a significantly lower incidence of postoperative RLN palsy as compared to the non-CNM group (P = 0.026: CNM vs. non-CRNM: 4.0% (1/25) vs. 31.2% (5/16)). The CNM group had a lower incidence of postoperative pneumoniae (CNM vs. non-CNM: 4.0% (1/25) vs. 18.8% (3/16)) and shorter days of postoperative hospital stay (CNM vs. non-CNM: 13 days vs. 41 days). Multivariate analysis revealed that the CNM use (odds ratio 0.07; 95% CI 0.05–0.98) was an independent factor avoiding postoperative RLN palsy.

Conclusion

The CNM for RLN contributes to a remarkable reduction in the risk of postoperative RLN palsy and improvement in outcomes in single-port mediastinoscopic radical esophagectomy.

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References

  1. Matsubara T, Ueda M, Abe T, Akimori T, Kokudo N, Takahashi T. Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus. Br J Surg. 1999;86(5):669-73. https://doi.org/10.1046/j.1365-2168.1999.01067.x.

    Article  CAS  PubMed  Google Scholar 

  2. Fujita H, Sueyoshi S, Tanaka T, Fujii T, Toh U, Mine T et al. Optimal lymphadenectomy for squamous cell carcinoma in the thoracic esophagus: comparing the short- and long-term outcome among the four types of lymphadenectomy. World J Surg. 2003;27(5):571-9. https://doi.org/10.1007/s00268-003-6913-z.

    Article  PubMed  Google Scholar 

  3. Tachimori Y, Nagai Y, Kanamori N, Hokamura N, Igaki H. Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus. 2011;24(1):33-8. https://doi.org/10.1111/j.1442-2050.2010.01086.x.

    Article  CAS  PubMed  Google Scholar 

  4. Udagawa H, Ueno M, Shinohara H, Haruta S, Kaida S, Nakagawa M et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol. 2012;106(6):742-7. https://doi.org/10.1002/jso.23122.

    Article  PubMed  Google Scholar 

  5. Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256(1):95-103. https://doi.org/10.1097/SLA.0b013e3182590603.

    Article  PubMed  Google Scholar 

  6. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T et al. Mapping of Lymph Node Metastasis From Esophagogastric Junction Tumors: A Prospective Nationwide Multicenter Study. Ann Surg. 2021;274(1):120-7. https://doi.org/10.1097/sla.0000000000003499.

    Article  PubMed  Google Scholar 

  7. Hulscher JB, van Sandick JW, Devriese PP, van Lanschot JJ, Obertop H. Vocal cord paralysis after subtotal oesophagectomy. Br J Surg. 1999;86(12):1583-7. https://doi.org/10.1046/j.1365-2168.1999.01333.x.

    Article  CAS  PubMed  Google Scholar 

  8. Gockel I, Kneist W, Keilmann A, Junginger T. Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma. Eur J Surg Oncol. 2005;31(3):277-81. https://doi.org/10.1016/j.ejso.2004.10.007.

    Article  CAS  PubMed  Google Scholar 

  9. Oshikiri T, Takiguchi G, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K et al. Postoperative recurrent laryngeal nerve palsy is associated with pneumonia in minimally invasive esophagectomy for esophageal cancer. Surg Endosc. 2021;35(2):837-44. https://doi.org/10.1007/s00464-020-07455-1.

    Article  PubMed  Google Scholar 

  10. Sato Y, Kosugi S, Aizawa N, Ishikawa T, Kano Y, Ichikawa H et al. Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma. World J Surg. 2016;40(1):129-36. https://doi.org/10.1007/s00268-015-3261-8.

    Article  PubMed  Google Scholar 

  11. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32(7):1358-66. https://doi.org/10.1007/s00268-008-9483-2.

    Article  CAS  PubMed  Google Scholar 

  12. Schneider R, Machens A, Sekulla C, Lorenz K, Elwerr M, Dralle H. Superiority of continuous over intermittent intraoperative nerve monitoring in preventing vocal cord palsy. Br J Surg. 2021;108(5):566-73. https://doi.org/10.1002/bjs.11901.

    Article  CAS  PubMed  Google Scholar 

  13. Zhong D, Zhou Y, Li Y, Wang Y, Zhou W, Cheng Q et al. Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer. Dis Esophagus. 2014;27(5):444-51. https://doi.org/10.1111/j.1442-2050.2012.01414.x.

    Article  CAS  PubMed  Google Scholar 

  14. Hikage M, Kamei T, Nakano T, Abe S, Katsura K, Taniyama Y et al. Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection. Surg Endosc. 2017;31(7):2986-96. https://doi.org/10.1007/s00464-016-5317-8.

    Article  PubMed  Google Scholar 

  15. Kobayashi H, Kondo M, Mizumoto M, Hashida H, Kaihara S, Hosotani R. Technique and surgical outcomes of mesenterization and intra-operative neural monitoring to reduce recurrent laryngeal nerve paralysis after thoracoscopic esophagectomy: A cohort study. Int J Surg. 2018;56:301-6. https://doi.org/10.1016/j.ijsu.2018.05.738.

    Article  PubMed  Google Scholar 

  16. Takeda S, Iida M, Kanekiyo S, Nishiyama M, Tokumitsu Y, Shindo Y et al. Efficacy of intraoperative recurrent laryngeal neuromonitoring during surgery for esophageal cancer. Ann Gastroenterol Surg. 2021;5(1):83-92. https://doi.org/10.1002/ags3.12394.

    Article  PubMed  Google Scholar 

  17. Fujimoto D, Taniguchi K, Kobayashi H. Intraoperative neuromonitoring during prone thoracoscopic esophagectomy for esophageal cancer reduces the incidence of recurrent laryngeal nerve palsy: a single-center study. Updates Surg. 2021;73(2):587-95. https://doi.org/10.1007/s13304-020-00967-4.

    Article  PubMed  Google Scholar 

  18. Wang X, Guo H, Hu Q, Ying Y, Chen B. Efficacy of Intraoperative Recurrent Laryngeal Nerve Monitoring During Thoracoscopic Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-Analysis. Front Surg. 2021;8:773579. https://doi.org/10.3389/fsurg.2021.773579.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Tsang RK, Law S. Adaptation of Continuous Intraoperative Vagus Nerve Stimulation for Monitoring of Recurrent Laryngeal Nerve During Minimally Invasive Esophagectomy. World J Surg. 2016;40(1):137-41. https://doi.org/10.1007/s00268-015-3265-4.

    Article  PubMed  Google Scholar 

  20. Wong I, Tong DKH, Tsang RKY, Wong CLY, Chan DKK, Chan FSY et al. Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy. J Vis Surg. 2017;3:9. https://doi.org/10.21037/jovs.2016.12.11.

  21. Wong IYH, Zhang RQ, Tsang RKY, Kwok JYY, Wong CLY, Chan DKK et al. Improving Outcome of Superior Mediastinal Lymph Node Dissection During Esophagectomy: A Novel Approach Combining Continuous and Intermittent Recurrent Laryngeal Nerve Monitoring. Ann Surg. 2021;274(5):736-42. https://doi.org/10.1097/sla.0000000000005096.

    Article  PubMed  Google Scholar 

  22. Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D et al. Single-Port Mediastinoscopic Lymphadenectomy Along the Left Recurrent Laryngeal Nerve. Ann Thorac Surg. 2015;100(3):1115-7. https://doi.org/10.1016/j.athoracsur.2015.03.122.

    Article  PubMed  Google Scholar 

  23. Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D et al. Perioperative outcomes of single-port mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer. Dis Esophagus. 2017;30(10):1-8. https://doi.org/10.1093/dote/dox047.

    Article  CAS  PubMed  Google Scholar 

  24. Mori K, Yamagata Y, Aikou S, Nishida M, Kiyokawa T, Yagi K et al. Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery. Dis Esophagus. 2016;29(5):429-34. https://doi.org/10.1111/dote.12345.

    Article  CAS  PubMed  Google Scholar 

  25. Hemmerling TM, Schmidt J, Jacobi KE, Klein P. Intraoperative monitoring of the recurrent laryngeal nerve during single-lung ventilation in esophagectomy. Anesth Analg. 2001;92(3):662-4. https://doi.org/10.1097/00000539-200103000-00021.

    Article  CAS  PubMed  Google Scholar 

  26. Baba Y, Yoshida N, Shigaki H, Iwatsuki M, Miyamoto Y, Sakamoto Y et al. Prognostic Impact of Postoperative Complications in 502 Patients With Surgically Resected Esophageal Squamous Cell Carcinoma: A Retrospective Single-institution Study. Ann Surg. 2016;264(2):305-11. https://doi.org/10.1097/sla.0000000000001510.

    Article  PubMed  Google Scholar 

  27. Kataoka K, Takeuchi H, Mizusawa J, Igaki H, Ozawa S, Abe T et al. Prognostic Impact of Postoperative Morbidity After Esophagectomy for Esophageal Cancer: Exploratory Analysis of JCOG9907. Ann Surg. 2017;265(6):1152-7. https://doi.org/10.1097/sla.0000000000001828.

    Article  PubMed  Google Scholar 

  28. Nakauchi M, Uyama I, Suda K, Shibasaki S, Kikuchi K, Kadoya S et al. Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series. Esophagus. 2019;16(1):85-92. https://doi.org/10.1007/s10388-018-0634-8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Digestive Surgery (Esophageal and Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Shuhei Komatsu, Tomoki Konishi, Daiki Matsubara, Koji Soga, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi & Yasuhiro Shioaki

  2. Division of Digestive Surgery (Esophageal and Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Shuhei Komatsu, Hitoshi Fujiwara & Eigo Otsuji

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  1. Shuhei Komatsu
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  2. Tomoki Konishi
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  3. Daiki Matsubara
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Correspondence to Shuhei Komatsu.

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Komatsu, S., Konishi, T., Matsubara, D. et al. Continuous Recurrent Laryngeal Nerve Monitoring During Single-Port Mediastinoscopic Radical Esophagectomy for Esophageal Cancer. J Gastrointest Surg 26, 2444–2450 (2022). https://doi.org/10.1007/s11605-022-05472-0

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