Wang Xinxin, Guo Haixie, Hu Quanteng, Ying Yongquan, Chen Baofu
Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China.
Front Surg. 2021 Nov 3;8:773579. doi: 10.3389/fsurg.2021.773579. eCollection 2021.
Recurrent laryngeal nerve paralysis (RLNP), a severe complication of mini-invasive esophagectomy, usually occurs during lymphadenectomy adjacent to recurrent laryngeal nerve. This systematic review and meta-analysis aimed to evaluate the efficacy of intraoperative nerve monitoring (IONM) in reducing RLNP incidence during mini-invasive esophagectomy. Systematic literature search of PubMed, EMBASE, EBSCO, Web of Knowledge, and Cochrane Library until June 4, 2021 was performed using the terms "(nerve monitoring) OR neuromonitoring OR neural monitoring OR recurrent laryngeal nerve AND (esophagectomy OR esophageal)." Primary outcome was postoperative RLNP incidence. Secondary outcomes were sensitivity, specificity, and positive and negative predictive values for IONM; complications after esophagectomy; number of dissected lymph nodes; operation time; and length of hospital stay. Among 2,330 studies, five studies comprising 509 patients were eligible for final analysis. The RLNP incidence was significantly lower (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.12-0.88, < 0.05), the number of dissected mediastinal lymph nodes was significantly higher (mean difference 4.30, 95%CI 2.75-5.85, < 0.001), and the rate of hoarseness was significantly lower (OR 0.14, 95%CI 0.03-0.63, = 0.01) in the IONM group than in the non-IONM group. The rates of aspiration (OR 0.31, 95%CI 0.06-1.64, = 0.17), pneumonia (OR 1.08, 95%CI 0.70-1.67, = 0.71), and operation time (mean difference 7.68, 95%CI -23.60-38.95, = 0.63) were not significantly different between the two groups. The mean sensitivity, specificity, and positive and negative predictive values for IONM were 53.2% (0-66.7%), 93.7% (54.8-100%), 71.4% (0-100%), and 87.1% (68.0-96.6%), respectively. IONM was a feasible and effective approach to minimize RLNP, improve lymphadenectomy, and reduce hoarseness after thoracoscopic esophagectomy for esophageal cancer, although IONM did not provide significant benefit in reducing aspiration, pneumonia, operation time, and length of hospital stay.
喉返神经麻痹（RLNP）是微创食管切除术的一种严重并发症，通常发生在喉返神经附近的淋巴结清扫术中。本系统评价和荟萃分析旨在评估术中神经监测（IONM）在降低微创食管切除术中RLNP发生率方面的疗效。使用“（神经监测）或神经监护或神经监测或喉返神经和（食管切除术或食管）”等术语，对截至2021年6月4日的PubMed、EMBASE、EBSCO、Web of Knowledge和Cochrane图书馆进行了系统的文献检索。主要结局是术后RLNP发生率。次要结局包括IONM的敏感性、特异性、阳性和阴性预测值；食管切除术后的并发症；清扫淋巴结的数量；手术时间；以及住院时间。在2330项研究中，有5项研究共509例患者符合最终分析的条件。与非IONM组相比，IONM组的RLNP发生率显著降低（比值比[OR]0.33，95%置信区间[CI]0.12 - 0.88，P<0.05），清扫的纵隔淋巴结数量显著增多（平均差值4.30，95%CI 2.75 - 5.85，P<0.001），声音嘶哑发生率显著降低（OR 0.14，95%CI 0.03 - 0.63，P = 0.01）。两组之间的误吸发生率（OR 0.31，95%CI 0.06 - 1.64，P = 0.17）、肺炎发生率（OR 1.08，95%CI 0.70 - 1.67，P = 0.71）和手术时间（平均差值7.68，95%CI -23.60 - 38.95，P = 0.63）无显著差异。IONM的平均敏感性、特异性、阳性和阴性预测值分别为53.2%（0 - 66.7%）、93.7%（54.8 - 100%）、71.4%（0 - 100%）和87.1%（68.0 - 96.6%）。IONM是一种可行且有效的方法，可将胸腔镜食管癌切除术后的RLNP降至最低，改善淋巴结清扫，并减少声音嘶哑，尽管IONM在降低误吸、肺炎、手术时间和住院时间方面未提供显著益处。
