Peyser Cardoso Rayner, Agarwal Lokesh, Cardoso Swizel Ann, Agarwal Ayushi, Varshney Vaibhav, Soni Subhash, Selvakumar B, Varshney Peeyush
Department of General Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Dis Esophagus. 2025 Jan 7;38(1). doi: 10.1093/dote/doae116.
Esophagectomy and lymphadenectomy for esophageal cancer carry an inherent risk of recurrent laryngeal nerve (RLN) injury. Intraoperative nerve monitoring (IONM) may help prevent RLN damage, though evidence on its effectiveness is still limited. This systematic review and meta-analysis (SRMA) evaluate the feasibility and efficacy of IONM during minimally invasive esophagectomy (MIE) for esophageal cancer. This SRMA followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, with a registered protocol on PROSPERO (CRD42022367916). Two independent authors conducted a comprehensive literature search across multiple databases, screening studies on MIE for esophageal cancer using IONM. Case-control studies were included, focusing on the RLN palsy (RLNP) rate as the primary outcome. A total of 11 studies involving 1907 patients (IONM group: 752 patients; non-IONM group: 1155 patients) were included in the SRMA. IONM significantly reduced the incidence of RLNP (OR = 0.47, P < 0.001). Length of hospital stay (LOHS) and lower respiratory tract infection (LRTI) rates were significantly reduced with IONM use. No significant differences were observed in anastomotic leak, chylothorax, total number of lymph nodes dissected, operation time, aspiration rates, or intraoperative blood loss. The pooled sensitivity and specificity of IONM for detecting RLN injury were 83.3% and 81%, respectively. IONM during MIE significantly reduces the incidence of RLNP, postoperative LRTI, and shortens the LOHS, without adding operative risks. Further research is needed to evaluate its long-term survival benefits and cost-effectiveness.
食管癌的食管切除术和淋巴结清扫术存在喉返神经（RLN）损伤的固有风险。术中神经监测（IONM）可能有助于预防RLN损伤，但其有效性的证据仍然有限。本系统评价和荟萃分析（SRMA）评估了IONM在微创食管癌切除术（MIE）中的可行性和有效性。本SRMA遵循系统评价和荟萃分析的首选报告项目（PRISMA）以及流行病学观察性研究的荟萃分析（MOOSE）指南，并在PROSPERO上注册了方案（CRD42022367916）。两位独立作者对多个数据库进行了全面的文献检索，筛选了使用IONM进行MIE治疗食管癌的研究。纳入病例对照研究，重点关注RLN麻痹（RLNP）率作为主要结局。SRMA共纳入11项研究，涉及1907例患者（IONM组：752例患者；非IONM组：1155例患者）。IONM显著降低了RLNP的发生率（OR = 0.47，P < 0.001）。使用IONM可显著降低住院时间（LOHS）和下呼吸道感染（LRTI）率。在吻合口漏、乳糜胸、清扫淋巴结总数、手术时间、误吸率或术中失血量方面未观察到显著差异。IONM检测RLN损伤的合并敏感性和特异性分别为83.3%和81%。MIE期间的IONM显著降低了RLNP的发生率、术后LRTI，并缩短了LOHS，且不增加手术风险。需要进一步研究来评估其长期生存益处和成本效益。
