Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan.
Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan.
Esophagus. 2022 Apr;19(2):233-239. doi: 10.1007/s10388-021-00890-6. Epub 2021 Oct 27.
Hoarseness is one of the classical symptoms in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), and it results from recurrent laryngeal nerve palsy, which is caused by nodal metastasis along the recurrent laryngeal nerve or by main tumors. We reviewed the short-term and long-term results of esophagectomy for patients with locally advanced ESCC and hoarseness at diagnosis.
Patients who initially presented with hoarseness from recurrent laryngeal nerve palsy between 2009 and 2018 and underwent esophagectomy for thoracic ESCC were eligible for this study. Pharyngolaryngectomy or cervical ESCC were exclusionary.
A total of 15 patients were eligible, and 14 underwent resection of the recurrent laryngeal nerves. The remaining patient had nerve-sparing surgery. Nine patients (60%) had post-operative complications ≥ Clavien-Dindo class II and, pulmonary complications were most common. Two patients (13%) died in the hospital. The 5-year overall survival rate for all patients was 16%. Age (≤ 65 years), cT1/T2 tumor, and remarkably good response to neoadjuvant treatment were likely related to longer survival; however, these relationships were not statistically significant.
Esophagectomy for ESCC patients who are diagnosed with recurrent laryngeal nerve paralysis at initial presentation could be a treatment option if the patient is relatively young, has a cT1/T2 tumor, or shows a remarkably good response to neoadjuvant treatment. However, clinicians should be aware of the possibility of postoperative pulmonary complications, which were frequently observed with the procedure.
声音嘶哑是局部晚期胸段食管鳞状细胞癌（ESCC）患者的经典症状之一，其由喉返神经麻痹引起，而喉返神经麻痹可由沿喉返神经的淋巴结转移或主肿瘤引起。我们回顾了诊断时存在声音嘶哑的局部晚期 ESCC 患者接受食管切除术的短期和长期结果。
2009 年至 2018 年间，最初因喉返神经麻痹出现声音嘶哑且接受胸段 ESCC 食管切除术的患者符合本研究条件。排除咽-喉切除术或颈段 ESCC。
共有 15 名患者符合条件，其中 14 名患者行喉返神经切除术，其余患者行保留神经的手术。9 名患者（60%）发生术后并发症≥Clavien-Dindo Ⅱ级，最常见的是肺部并发症。2 名患者（13%）在医院内死亡。所有患者的 5 年总生存率为 16%。年龄（≤65 岁）、cT1/T2 肿瘤和新辅助治疗的显著良好反应可能与更长的生存时间相关，但这些关系没有统计学意义。
如果患者相对年轻、肿瘤为 cT1/T2 或对新辅助治疗有显著良好反应，则诊断为初始出现喉返神经麻痹的 ESCC 患者可选择食管切除术，但临床医生应注意该手术术后肺部并发症的可能性，该并发症较为常见。
