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.

中文翻译：

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食管切除术中的术中神经监测可降低喉返神经麻痹的风险

背景

尽管食管切除术期间存在喉返神经 (RLN) 麻痹的风险，但目前尚无既定的监测 RLN 损伤的方法。

方法

本研究纳入了 2011 年至 2018 年期间接受食管切除术的 187 名患者。其中，142 名患者（IONM 组）进行了术中神经监测（IONM），其余 45 名患者接受了常规手术，未进行 IONM（对照组）。我们调查了与使用 IONM 有关的术后并发症的发生率。

结果

术后 RLN 麻痹的总发生率为 28% (52/187)。与对照组相比，IONM 组术后 RLN 麻痹的发生率显着降低 ( p  = 0.004)。Clavien-Dindo (CD) 分级超过 2 级的患者术后肺炎的总发生率为 22% (41/187)。任何级别的术后肺炎发生率与使用 IONM 之间无显着差异（p  = 0.195 和 0.333；分别为 CD > 2 和 > 3）。多变量分析表明，上三分之一的肿瘤 [比值比 (OR) 3.12；95% 置信区间 (CI) 1.04–9.29] 和未使用 IONM (OR 2.51; 95% CI 1.17–5.38) 是导致食管切除术后 RLN 麻痹的独立因素。

结论

IONM 有助于降低食管癌手术后 RLN 麻痹的风险。