Skip to main content

Advertisement

Log in

Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The problem of recurrent laryngeal nerve (RLN) paralysis (RLNP) after radical esophagectomy remains unresolved. Several studies have confirmed that intraoperative nerve monitoring (IONM) of the RLN during thyroid surgery substantially decreases the incidence of RLN damage. This study tried to determine the feasibility and effectiveness of IONM of the RLN during thoracoscopic esophagectomy in the prone position for esophageal cancer.

Methods

All 108 patients who underwent prone esophagectomy at Tohoku University Hospital between July 2012 and March 2015 were included in this study. We divided patients into two groups: a control group (No-Monitoring group, surgery without IONM; n = 54) and a study group (Monitoring group, surgery with IONM; n = 54). In Monitoring group, neural stimulation was performed for both RLNs before and after dissection in the thoracic procedure, then for RLNs and vagus nerves (VNs) in the cervical procedure. The feasibility of IONM in Monitoring group and early surgical outcomes were retrospectively compared with those in No-Monitoring group.

Results

IONM could be performed for 47 cases (87.0%) in Monitoring group. Reasons for discontinuation were use of muscle relaxants (3 patients), change in thoracotomy procedure (2 patients), past rib bone fracture (1 patient), and allergic shock by transfusion (1 patient). Right RLNPs were identified postoperatively in 4 patients, and left RLNPs in 23 patients. IONM sensitivities were 92.7 and 88.0% for the right and left VNs, respectively. Incidences of postoperative RLNP, aspiration, and primary pneumonia did not differ significantly between groups.

Conclusions

This study confirmed the feasibility and safety of IONM of the RLN for thoracoscopic esophagectomy in the prone position. No significant differences in postoperative outcomes were seen between esophagectomy with and without IONM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nishihira T, Hirayama K, Mori S (1998) A prospective randomized trial of extended cervical and superior mediastinal lymphadenectomy for carcinoma of the thoracic esophagus. Am J Surg 175(1):47–51

    Article  CAS  PubMed  Google Scholar 

  2. Fujita H, Sueyoshi S, Tanaka T, Shirouzu K (2002) Three-field dissection for squamous cell carcinoma in the thoracic esophagus. Ann Thorac Cardiovasc Surg 8(6):328–335

    PubMed  Google Scholar 

  3. Fujita H, Sueyoshi S, Tanaka T, Fujii T, Toh U, Mine T, Sasahara H, Sudo T, Matono S, Yamana H, Shirouzu K (2003) 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 27(5):571–579

    Article  PubMed  Google Scholar 

  4. Kang CH, Kim YT, Jeon SH, Sung SW, Kim JH (2007) Lymphadenectomy extent is closely related to long-term survival in esophageal cancer. Eur J Cardiothorac Surg 31(2):154–160

    Article  PubMed  Google Scholar 

  5. Matsubara T, Ueda M, Abe T, Akimori T, Kokudo N, Takahashi T (1999) Unique distribution patterns of metastatic lymph nodes in patients with superficial carcinoma of the thoracic oesophagus. Br J Surg 86(5):669–673

    Article  CAS  PubMed  Google Scholar 

  6. Jang HJ, Lee HS, Kim MS, Lee JM, Zo JI (2011) Patterns of lymph node metastasis and survival for upper esophageal squamous cell carcinoma. Ann Thorac Surg 92(3):1091–1097

    Article  PubMed  Google Scholar 

  7. Tachimori Y, Nagai Y, Kanamori N, Hokamura N, Igaki H (2011) Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus 24(1):33–38

    Article  CAS  PubMed  Google Scholar 

  8. Shen Y, Zhang Y, Tan L, Feng M, Wang H, Khan MA, Liang M, Wang Q (2012) Extensive mediastinal lymphadenectomy during minimally invasive esophagectomy: optimal results from a single center. J Gastrointest Surg 16(4):715–721

    Article  PubMed  Google Scholar 

  9. Taniyama Y, Miyata G, Kamei T, Nakano T, Abe S, Katsura K, Sakurai T, Teshima J, Hikage M, Ohuchi N (2015) Complications following recurrent laryngeal nerve lymph node dissection in oesophageal cancer surgery. Interact CardioVasc Thorac Surg 20(1):41–46

    Article  PubMed  Google Scholar 

  10. Gockel I, Kneist W, Keilmann A, Junginger T (2005) Recurrent laryngeal nerve paralysis (RLNP) following esophagectomy for carcinoma. Eur J Surg Oncol 31(3):277–281

    Article  CAS  PubMed  Google Scholar 

  11. Hulscher JB, van Sandick JW, Devriese PP, van Lanschot JJ, Obertop H (1999) Vocal cord paralysis after subtotal oesophagectomy. Br J Surg 86(12):1583–1587

    Article  CAS  PubMed  Google Scholar 

  12. Fujita H, Kakegawa T, Yamana H, Shima I, Toh Y, Tomita Y, Fujii T, Yamasaki K, Higaki K, Noake T (1995) Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg 222(5):654–662

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Swanson SJ, Batirel HF, Bueno R, Jaklitsch MT, Lukanich JM, Allred E, Mentzer SJ, Sugarbaker DJ (2001) Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 72(6):1918–1924 discussion 1924-1925

    Article  CAS  PubMed  Google Scholar 

  14. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32(7):1358–1366

    Article  Google Scholar 

  15. Dralle H, Sekulla C, Lorenz K, Nguyen Thanh P, Schneider R, Machens A (2012) Loss of the nerve monitoring signal during bilateral thyroid surgery. Br J Surg 99(8):1089–1095

    Article  CAS  PubMed  Google Scholar 

  16. Alesina PF, Rolfs T, Hommeltenberg S, Hinrichs J, Meier B, Mohmand W, Hofmeister S, Walz MK (2012) Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: results of a retrospective comparative analysis. World J Surg 36(6):1348–1353

    Article  PubMed  Google Scholar 

  17. Dionigi G, Alesina PF, Barczynski M, Boni L, Chiang FY, Kim HY, Materazzi G, Randolph GW, Terris DJ, Wu CW (2012) Recurrent laryngeal nerve injury in video-assisted thyroidectomy: lessons learned from neuromonitoring. Surg Endosc 26(9):2601–2608

    Article  CAS  PubMed  Google Scholar 

  18. Brauckhoff M, Gimm O, Thanh PN, Brauckhoff K, Ukkat J, Thomusch O, Dralle H (2002) Injury to recurrent laryngeal nerves during thyroidectomy. First experiences in intraoperative neurostimulation of the recurrent laryngeal nerve during thyroid surgery of children and adolescents. J Pediatr Surg 37(10):1414–1418

    Article  PubMed  Google Scholar 

  19. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Mühlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(6):1310–1322

    Article  PubMed  Google Scholar 

  20. Hemmerling TM, Schmidt J, Jacobi KE, Klein P (2001) Intraoperative monitoring of the recurrent laryngeal nerve during single-lung ventilation in esophagectomy. Anesth Analg 92(3):662–664

    Article  CAS  PubMed  Google Scholar 

  21. Gelpke H, Grieder F, Decurtins M, Cadosch D (2010) Recurrent laryngeal nerve monitoring during esophagectomy and mediastinal lymph node dissection. World J Surg 34(10):2379–2382

    Article  PubMed  Google Scholar 

  22. Garas George, Kayani Babar, Tolley Neil, Palazzo Fausto, Athanasiou Thanos, Zacharakis Emmanouil (2013) Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer? Int J Surg 11(5):370–373

    Article  PubMed  Google Scholar 

  23. Zhong D, Zhou Y, Li Y, Wang Y, Zhou W, Cheng Q, Chen L, Zhao J, Li X, Yan X (2014) Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer. Dis Esophagus 27(5):444–451

    Article  CAS  PubMed  Google Scholar 

  24. Ikeda Y, Inoue T, Ogawa E, Horikawa M, Inaba T, Fukushima R (2014) Recurrent laryngeal nerve monitoring during thoracoscopic esophagectomy. World J Surg 38(4):897–901

    Article  PubMed  Google Scholar 

  25. Palanivelu C, Prakash A, Senthikumar R, Senthilnathan P, parthasarathi R, Rajan PS, Venkatachlam S (2006) Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg 203(1):7–16

    Article  PubMed  Google Scholar 

  26. Fabian T, Martin J, Katigbak M, McKelvey AA, Federico JA (2008) Thoracoscopic esophageal mobilization during minimally invasive esophagectomy: a head-to-head comparison of prone versus decubitus positions. Surg Endosc 22(11):2485–2491

    Article  PubMed  Google Scholar 

  27. Noshiro H, Iwasaki H, Kobayashi K, Uchiyama A, Miyasaka Y, Masatsugu T, Koike K, Miyazaki K (2010) Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer. Surg Endosc 24(12):2965–2973

    Article  PubMed  Google Scholar 

  28. Yatabe T, Kitagawa H, Yamashita K, Hanazaki K, Yokoyama M (2013) Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today 43(4):386–391

    Article  PubMed  Google Scholar 

  29. Teshima J, Miyata G, Kamei T, Nakano T, Abe S, Katsura K, Taniyama Y, Sakurai T, Hikage M, Nakamura T, Takaya K, Zuguchi M, Okamoto H, Youhei O, Ohuchi N (2015) Comparison of short-term outcomes between prone and lateral decubitus positions for thoracoscopic esophagectomy. Surg Endosc 29:2756–2762

    Article  PubMed  Google Scholar 

  30. Eisele DW (1996) Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope 106(4):443–449

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank T. Nakagawa, K. Takaya, C. Sato, and K. Kamiya for helpful discussion, Prof. M. Yamauchi for technical guidance, and M. Tokunaga for help with paper organization. This work was supported by Grants-in-Aid for Scientific Research in Priority Areas from the Japan MEXT (T. Nakano and N. Ohuchi).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Makoto Hikage.

Ethics declarations

Disclosures

Drs. Makoto Hikage, Takashi Kamei, Toru Nakano, Shigeo Abe, Kazunori Katsura, Yusuke Taniyama, Tadashi Sakurai, Jin Teshima, Soichi Ito, Nobuchika Niizuma, Hiroshi Okamoto, Toshiaki Fukutomi, Masato Yamada, Shota Maruyama, and Noriaki Ohuchi have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 29 kb)

Supplementary material 2 (DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hikage, M., Kamei, T., Nakano, T. et al. Impact of routine recurrent laryngeal nerve monitoring in prone esophagectomy with mediastinal lymph node dissection. Surg Endosc 31, 2986–2996 (2017). https://doi.org/10.1007/s00464-016-5317-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-5317-8

Keywords

Navigation