Y. Saito1, H. Takeuchi1, K. Fukuda1, R. Nakamura1, T. Takahashi1, N. Wada1, H. Kawakubo1, Y. Kitagawa1 1Keio University,Department Of Surgery,Shinjuku-ku, TOKYO, Japan
Introduction:
Recurrent laryngeal nerve paralysis is one of the most frequent and serious complications after esophageal cancer surgery. Recurrent laryngeal nerves are thin, about 1 to 2mm in size. In this study, we hypothesized that thin recurrent laryngeal nerve may affect postoperative vocal cord paralysis. We evaluated relations of left recurrent laryngeal nerve size and postoperative left vocal cord paralysis.
Methods:
This follow-back study included a total of 44 patients who underwent thoracoscopy assisted esophagectomy with lymphadenectomy along the recurrent laryngeal nerve from May 2012 to December 2013. When we exposed recurrent laryngeal nerves, we used single use scissor tips (Microline Surgical, Inc.). Diameter of the nerves were measured using the digital video recording of surgical procedures by the ratio between scissor and left recurrent laryngeal nerve. Median size of left recurrent laryngeal nerve for the 44 patients was 1.51mm. To evaluate relations of left recurrent laryngeal nerve size and postoperative vocal cord paralysis we compared patients with thin nerve and those with thick nerve. Twenty two patients had left recurrent laryngeal nerves under 1.5mm in size (thin group) and 22 patients had the nerves over 1.5mm (thick group). The average age was 63.2 years old (a range of 35-78), and 34 men and 10 females were included. For evaluation of vocal cord paralysis, a direct laryngoscopy and/or X-ray fluoroscopic test of swelling were performed after the operation.
Results:
There was not significant difference in the background factors, including age, sex, body-mass index, performance status, stage, histological type, or the location of tumor, in both groups. Operation time did not have the significant difference in both groups. The amounts of bleeding at thick group was significantly small. There was not the significant difference in metastasis of lymph nodes along left recurrent laryngeal nerve or the number of dissected lymph nodes along left recurrent laryngeal nerve in both groups. Incidence of postoperative left recurrent laryngeal nerve paralysis (Clavien-Dindo classification ≥ 1) was significantly higher (n=14, 63.6%vs n=5, 22.7%; p=0.006) in thin group.
Conclusion:
The recurrent laryngeal nerve paralysis was easy to be caused in the case that recurrent laryngeal nerve was thin.