Fu Shuwen, Guo Ying, Lu Xiaofan, Song Xiong, Qin Weiyi, Zheng Liquan, Huang Xiaofeng, Xie Manxiu, Lu Yali, Lai Renchun
Department of Anesthesiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, 74 Zhongshan Rd 2, Guangzhou, China.
Department of Clinical Research, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China.
Langenbecks Arch Surg. 2025 May 14;410(1):158. doi: 10.1007/s00423-025-03732-6.
Recurrent laryngeal nerve paralysis (RLNP) is a critical postoperative complication in esophagectomy. Intraoperative nerve monitoring (IONM) is a technique that can be used in high-risk surgeries to prevent, identify, and mitigate nerve damage. In this prospective study, we evaluated the feasibility and effectiveness of IONM in open McKeown esophagectomy for esophageal cancer.
From December 2020 to September 2023, 88 patients diagnosed with esophageal cancer were enrolled to receive IONM for open McKeown esophagectomy at Cancer Center, Sun Yat-sen University. The primary outcome was the incidence of RLNP after extubation. The secondary outcomes were postoperative complications, number of dissected lymph nodes, length of hospital stay, ICU duration and number of deaths.
A total of 83 patients were included in the final analysis. The incidence of RLNP after extubation was 30.1%. The occurrence of postoperative pulmonary complications was 20.5%. The median hospital stays were 13 days. The incidence of anastomotic leakage was 13.3%. No in-hospital deaths were reported. Postoperative RLNP prolonged the length of hospital stay (P = 0.042).
Our findings indicated that IONM could potentially be associated with a possible reduction in RLNP incidence following open McKeown esophagectomy for esophageal cancer. However, future research including well-designed randomized controlled trials may be beneficial to clarify these preliminary results.
ChiCTR2000029687 https://www.chictr.org.cn/showproj.html?proj=49103.
喉返神经麻痹（RLNP）是食管癌切除术后的一种严重并发症。术中神经监测（IONM）是一种可用于高风险手术以预防、识别和减轻神经损伤的技术。在这项前瞻性研究中，我们评估了IONM在开放性McKeown食管癌切除术中的可行性和有效性。
2020年12月至2023年9月，88例被诊断为食管癌的患者在中山大学肿瘤防治中心接受开放性McKeown食管癌切除术并进行IONM。主要结局是拔管后RLNP的发生率。次要结局包括术后并发症、清扫淋巴结数量、住院时间、重症监护病房（ICU）停留时间和死亡人数。
最终分析纳入83例患者。拔管后RLNP的发生率为30.1%。术后肺部并发症的发生率为20.5%。中位住院时间为13天。吻合口漏的发生率为13.3%。未报告院内死亡病例。术后RLNP延长了住院时间（P = 0.042）。
我们的研究结果表明，IONM可能与开放性McKeown食管癌切除术后RLNP发生率的降低有关。然而，未来包括精心设计的随机对照试验在内的研究可能有助于阐明这些初步结果。
ChiCTR2000029687 https://www.chictr.org.cn/showproj.html?proj=49103
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