Original Scientific Articles
Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life?

https://doi.org/10.1016/S1072-7515(98)00295-6Get rights and content

Abstract

Background: Recurrent laryngeal nerve injury caused by esophageal cancer surgery is worrisome but often temporary; it is unclear when and how the paralysis is resolved. Hoarseness of voice from vocal cord paralysis (VCP) can have detrimental effects on postoperative patients. The aims of this study were to clarify the progress of nerve paralysis related to difficulty in talking after surgery and to assess whether hoarseness influences patient quality of life.

Study Design: Between 1985 and 1996, 141 esophageal cancer patients undergoing a resection by the Akiyama procedure were cancer free 1 year after surgery. Among them, 51 patients with VCP on discharge from the hospital were retrospectively reviewed. Their VCPs, body weights, and pulmonary functions were examined yearly. They were given a questionnaire relating to the difficulty in talking 1 year after surgery.

Results: VCP on discharge spontaneously healed within 1 year of surgery in 21 patients (41.2%), with the mean duration of difficulty in talking 5.7 months. The remaining 30 patients had persistent VCP 1 year after surgery; 4 VCPs spontaneously healed approximately 2 years after surgery. Eleven of the 30 patients with persistent VCP, who complained of severe hoarseness at 1 year postoperatively from inability to close the glottis during exertion, showed debilitation in performance status, abilities to go up stairs, and swallowing. In the group of patients with severe hoarseness, the percentage of ideal body weight (90.6% ± 11.0%) preoperatively and pulmonary functions at 3 years postoperatively were deteriorated, resulting in 3 patients with repeated aspiration pneumonia.

Conclusions: The inability to compensate for aspiration, presenting as severe hoarseness, may be dependent on the preoperative nutritional state of patients along with degree of vocal cord atrophy and a decrease in pulmonary support. Persistent nerve paralysis deteriorates quality of life until it is adequately treated.

Section snippets

Methods

This study examined a total of 141 esophageal cancer patients who had undergone a resection by right thoracotomy, laparotomy, and cervicotomy combined with lymphadenectomy between January 1985 and March 1996 and who were cancer free 1 year after surgery. Their vocal cord movements were examined by an otolaryngologist preoperatively, on discharge from the hospital, and yearly after surgery. These inspections were routinely done by indirect examination using a mirror. More detailed observations

Results

The overall time course of healing of vocal cord palsy is shown in Table 1. Of the 51 patients, VCP on discharge was most frequently detected on the left side. VCP on discharge spontaneously healed 1 year after surgery in 21 patients (41.2%), with a mean duration of difficulty in talking 5.7 ± 2.0 months after surgery. The remaining 30 patients still had persistent VCP 1 year after surgery; 4 of the 30 spontaneously healed approximately 2 years after surgery. Spontaneous healing of VCP

Discussion

A systematic dissection of the recurrent nerve lymphatic chains commonly leads to recurrent nerve paralysis that presents itself as hoarseness, which is often deemed to be temporary.8, 9, 10, 11, 12 Neither the responsible site for the paralysis nor when and how the paralysis is restored are clear. In a previous report14 comparing patients who underwent transthoracic esophagectomy with three-field dissection and those without neck lymph node dissection, the rate of cord palsy was not different

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