Department of Thoracic Surgery, Peking Union Medical College Hospital, Beijing, China.
Dis Esophagus. 2022 Jul 12;35(7). doi: 10.1093/dote/doab080.
Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy.
A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared.
There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P < 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP.
IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.
纵隔淋巴结清扫术对于治疗食管鳞癌具有重要意义。然而，喉返神经（RLN）损伤是由 RLN 沿线淋巴结清扫引起的严重并发症。术中神经监测（IONM）可有效识别 RLN，降低术后声带麻痹（VCP）的发生率。在此，我们描述了 IONM 在微创 McKeown 食管切除术的可行性和有效性。
回顾性分析了 2016 年至 2020 年间接受微创 McKeown 食管切除术的 150 例患者的临床资料。我们将患者分为两组：神经监测组（IONM，n=70）和对照组（n=80）。分析并比较了两组的临床资料、手术变量和术后并发症。
两组患者的基线资料无显著差异。IONM 组术后 VCP 发生率为 8.6%（6 例），低于对照组的 21.3%（P=0.032）。术后肺部并发症在 IONM 组有 5 例（7.1%），对照组有 14 例（18.8%）（P=0.037）。IONM 组的术后住院时间明显短于对照组（8 天 vs. 12 天，中位数，P<0.001）。IONM 组 RLN 淋巴结清扫数目高于对照组（13.74±5.77 个 vs. 11.03±5.78 个，P=0.005）。IONM 监测 VCP 的灵敏度和特异度分别为 83.8%和 100%。信号降低的患者中，66.7%出现一过性 VCP，而信号完全丧失的患者均出现永久性 VCP。
IONM 应用于微创 McKeown 食管切除术是可行的。它在区分 RLN 和实现彻底的纵隔淋巴结清扫术方面具有优势，同时可减少 RLN 损伤。IONM 异常信号可准确预测术后 VCP 的发生。
