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



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.



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.



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.
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. m.hikage@scchr.jp.
Makoto
0000-0002-7641-5312
M
Hikage
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Takashi
T
Kamei
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Toru
T
Nakano
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Shigeo
S
Abe
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Kazunori
K
Katsura
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Yusuke
Y
Taniyama
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Tadashi
T
Sakurai
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Jin
J
Teshima
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Soichi
S
Ito
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Nobuchika
N
Niizuma
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Hiroshi
H
Okamoto
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Toshiaki
T
Fukutomi
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Masato
M
Yamada
Department of Surgery, Division of Organ Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Hospital, Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Shota
S
Maruyama
Department of Surgical Oncology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Noriaki
N
Ohuchi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D016684:Prone Position; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000517:prevention & control*
Esophageal cancer; Intraoperative nerve stimulation; Mediastinal lymph node dissection; Postoperative complication; Recurrent laryngeal nerve palsy; Thoracoscopic esophagectomy in prone position