1
|
Ozaki A, Mine S, Yoshino K, Fujiwara D, Nasu M, Hashiguchi T, Hashimoto T, Kajiyama Y, Tsurumaru M, Arakawa A. Outcomes of esophagectomy for patients with esophageal squamous cell carcinoma accompanied by recurrent laryngeal nerve palsy at diagnosis. Esophagus 2022; 19:233-239. [PMID: 34705146 PMCID: PMC8921150 DOI: 10.1007/s10388-021-00890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 10/06/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hoarseness is one of the classical symptoms in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), and it results from recurrent laryngeal nerve palsy, which is caused by nodal metastasis along the recurrent laryngeal nerve or by main tumors. We reviewed the short-term and long-term results of esophagectomy for patients with locally advanced ESCC and hoarseness at diagnosis. PATIENTS Patients who initially presented with hoarseness from recurrent laryngeal nerve palsy between 2009 and 2018 and underwent esophagectomy for thoracic ESCC were eligible for this study. Pharyngolaryngectomy or cervical ESCC were exclusionary. RESULTS A total of 15 patients were eligible, and 14 underwent resection of the recurrent laryngeal nerves. The remaining patient had nerve-sparing surgery. Nine patients (60%) had post-operative complications ≥ Clavien-Dindo class II and, pulmonary complications were most common. Two patients (13%) died in the hospital. The 5-year overall survival rate for all patients was 16%. Age (≤ 65 years), cT1/T2 tumor, and remarkably good response to neoadjuvant treatment were likely related to longer survival; however, these relationships were not statistically significant. CONCLUSIONS Esophagectomy for ESCC patients who are diagnosed with recurrent laryngeal nerve paralysis at initial presentation could be a treatment option if the patient is relatively young, has a cT1/T2 tumor, or shows a remarkably good response to neoadjuvant treatment. However, clinicians should be aware of the possibility of postoperative pulmonary complications, which were frequently observed with the procedure.
Collapse
Affiliation(s)
- Asako Ozaki
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Kouhei Yoshino
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Daisuke Fujiwara
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Motomi Nasu
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Tadasuke Hashiguchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Takashi Hashimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Yoshiaki Kajiyama
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Masahiko Tsurumaru
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, Juntendo University, 3-1-3, Hongo, Bunkyo-ku, Tokyo, 113-8431 Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Bird JH, Williams EJ, Heathcote KJ, Ayres L, De Zoysa N, King EV, Parry SD, Nouraei SAR. Interspecialty referral of oesophagogastric and pharyngolaryngeal cancers delays diagnosis and reduces patient survival: A matched case-control study. Clin Otolaryngol 2020; 45:370-379. [PMID: 31984641 DOI: 10.1111/coa.13510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pharyngolaryngeal and oesophagogastric cancers present with swallowing symptoms and as such, their clinical evaluation traverses boundaries between different specialties. We studied the incidence and significance of interspecialty cancer referrals (ICRs), that is, pharyngolaryngeal cancers first evaluated by gastroenterology and oesophagogastric cancers first evaluated by otolaryngology. DESIGN A subset analysis of our Integrated Aerodigestive Partnership's audit dataset, of all ICR patients, and an equal number of controls matched for age, sex and cancer subsite. MAIN OUTCOME MEASURES Information about patient age and presenting symptoms was recorded. The relationship between symptoms and ICR risk was examined with binary logistic regression. Referral-to-diagnosis latency was compared between ICR and control patients with unpaired Student's t test. Cox regression was used to identify independent predictors of overall survival. RESULTS Of 1130 patients with pharyngolaryngeal and oesophagogastric cancers between 2008 and 2018, 60 diagnoses (5.3%) were preceded by an ICR. Referral-to-diagnosis latency increased from 43 ± 50 days for control patients to 115 ± 140 days for ICR patients (P < .0001). Dysphagia significantly increased the risk of an ICR (odds ratio 3.34; 95% CI 1.30-8.56), and presence of classic gastroesophageal reflux symptoms (heartburn or regurgitation; OR 0.25; 95% CI 0.08-0.83) and "distal" symptoms (nausea/vomiting, abdominal pain or dyspepsia; OR 0.23; 95% CI 0.08-068) significantly reduced the risk. Eleven pharyngolaryngeal cancers (of 26; 42%) were missed by gastroenterology, and eight (of 34; 24%) oesophageal cancers were missed by otolaryngology. An ICR was an independent adverse prognostic risk factor on multivariable analysis (hazard ratio 1.76; 95% CI 1.11-2.73; P < .02; log-rank test). Two systemic root causes were poor visualisation of pharynx and larynx by per-oral oesophago-gastro-duodenoscopy (OGD) for pharyngolaryngeal cancers, and poor sensitivity (62.5%) of barium swallow when it was used to 'evaluate' oesophageal mucosa. CONCLUSIONS An interspecialty cancer referral occurs in a significant proportion of patients with foregut cancers. It almost triples the time to cancer diagnosis and is associated with a high incidence of missed cancers and diminished patient survival. It is a complex phenomenon, and its reduction requires an integrated approach between primary and secondary care, and within secondary care, to optimise referral pathways and ensure appropriate and expeditious specialist evaluation.
Collapse
Affiliation(s)
- Jon H Bird
- Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | | | - Kate J Heathcote
- Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Lachlan Ayres
- Department of Gastroenterology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Nilantha De Zoysa
- Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Emma V King
- Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sally D Parry
- Department of Gastroenterology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - S A Reza Nouraei
- Department of Ear Nose and Throat Surgery, Poole Hospital NHS Foundation Trust, Poole, UK.,Clinical Informatics Research Unit, University of Southampton, Southampton, UK
| |
Collapse
|
4
|
Koyanagi K, Igaki H, Iwabu J, Ochiai H, Tachimori Y. Recurrent Laryngeal Nerve Paralysis after Esophagectomy: Respiratory Complications and Role of Nerve Reconstruction. TOHOKU J EXP MED 2016; 237:1-8. [PMID: 26268885 DOI: 10.1620/tjem.237.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recurrent laryngeal nerve paralysis (RLNP) after esophagectomy is a common complication and associated with aspiration pneumonia. In this study, we assessed the risk of RLNP and the usefulness of immediate reconstruction of recurrent laryngeal nerve (RLN) to prevent respiratory complications after esophagectomy. Seven hundred and eighty-two consecutive patients underwent an esophagectomy with three-field lymph node dissection, simultaneous gastric conduit reconstruction, and cervical anastomosis. Vocal cord function was observed using a flexible laryngoscope. Reconstruction between RLN and ipsilateral vagus nerve was performed during esophagectomy. RLNP was observed in 229 (29.3%) of the patients after esophagectomy: 198 unilateral and 31 bilateral cases. Of the 198 unilateral RLNP, vocal cord paralysis was observed predominantly on the left side (82.7%). RLNP was significantly associated with postoperative respiratory complications (P < 0.001) requiring a tracheotomy (P < 0.001) and mechanical ventilation (P < 0.001) and was also associated with esophagogastric anastomotic leakage (P = 0.015); consequently, the postoperative hospital stay was longer for patients with RLNP (P < 0.001). A longer operation time (P < 0.001) and advanced age (P = 0.038) were identified as significant independent predictors of RLNP. Resection of the RLN together with metastatic nodes was performed in 29 cases. The patients underwent RLN reconstruction (n = 11) had a significantly shorter postoperative hospital stay than those without RLN reconstruction (n = 18) (P = 0.019). In conclusion, RLNP was related to a poorer postoperative course among patients undergoing an esophagectomy. New surgical technologies are recommended for prevention of RLNP.
Collapse
Affiliation(s)
- Kazuo Koyanagi
- Division of Esophageal Surgery, Department of Gastrointestinal Oncology, National Cancer Center Hospital
| | | | | | | | | |
Collapse
|
5
|
Capek S, Amrami KK, Spinner RJ. Gastroesophageal junction carcinoma and brachial plexopathy: An anatomic explanation via perineural spread. Clin Anat 2016; 29:800-3. [DOI: 10.1002/ca.22708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 02/26/2016] [Accepted: 02/26/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Stepan Capek
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
| | - Kimberly K. Amrami
- Department of Neurosurgery; Mayo Clinic; Rochester Minnesota
- Department of Radiology; Mayo Clinic; Rochester Minnesota
| | | |
Collapse
|
7
|
Natsugoe S, Okumura H, Matsumoto M, Ishigami S, Owaki T, Nakano S, Aikou T. Reconstruction of recurrent laryngeal nerve with involvement by metastatic node in esophageal cancer. Ann Thorac Surg 2006; 79:1886-9. [PMID: 15919278 DOI: 10.1016/j.athoracsur.2004.11.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Revised: 11/17/2004] [Accepted: 11/24/2004] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve paralysis represents one of the major complications in esophageal cancer surgery, and patients with esophageal cancer sometimes develop recurrent laryngeal nerve paralysis before treatment. We evaluated recurrent laryngeal nerve reconstruction in patients with lymph node metastasis infiltrating the recurrent laryngeal nerve. METHODS Five patients with preoperative recurrent laryngeal nerve paralysis as a result of involvement of metastasis were enrolled in the present study. Ansa cervicalis-recurrent laryngeal nerve anastomosis in the neck was performed in 4 patients and direct anastomosis of recurrent laryngeal nerve in the mediastinum in 1 patient. RESULTS Six months after surgery, 3 patients who had undergone ansa cervicalis-recurrent laryngeal nerve anastomosis in the neck displayed good quality of life without hoarseness or aspiration. The patient who underwent direct anastomosis of the recurrent laryngeal nerve in the mediastinum experienced occasional aspiration and hoarseness. The remaining patient displayed poor condition because of recurrent lung tumor, and quality of life was decreased. CONCLUSIONS If patients with recurrent laryngeal nerve paralysis before treatment can undergo potentially curative resection with lymph node dissection, including the metastatic lymph node infiltrating the recurrent laryngeal nerve, recurrent laryngeal nerve reconstruction should be performed to improve quality of life.
Collapse
Affiliation(s)
- Shoji Natsugoe
- Department of Surgical Oncology and Digestive Surgery, Kagoshima University School of Medicine, Kagoshima, Japan.
| | | | | | | | | | | | | |
Collapse
|
9
|
Taha H, Irfan S, Krishnamurthy M. Cisplatin induced reversible bilateral vocal cord paralysis: an undescribed complication of cisplatin. Head Neck 1999; 21:78-9. [PMID: 9890355 DOI: 10.1002/(sici)1097-0347(199901)21:1<78::aid-hed11>3.0.co;2-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Bilateral vocal cord paralysis is uncommon. Most cases occur secondary to trauma, malignancy, surgery, or intubation. Also, it was reported as a side effect of Vinca alkaloids. METHODS We report a patient with small cell lung cancer who developed bilateral vocal cord paralysis and needed to be intubated after treatment with cisplatin and etoposide. All workups excluded metastases as a cause of bilateral vocal cord paralysis. The patient required tracheostomy; she did not receive any further chemotherapy. After 11 weeks, vocal cord paralysis disappeared, tracheostomy was reversed, and the patient remained symptom free; however, 6 months later, the patient developed brain and liver metastases and died from her disease with no evidence of vocal cord paralysis. RESULTS We report a case of reversible bilateral vocal cord paralysis that we believe to be secondary to cisplatin toxicity, which is an undescribed complication of this drug. CONCLUSION Cisplatin can induce reversible bilateral vocal cord paralysis. The concurrent use of cisplatin and etoposide might have contributed to this complication in our patient.
Collapse
Affiliation(s)
- H Taha
- Department of Medicine, New York Methodist Hospital, Brooklyn, USA
| | | | | |
Collapse
|
10
|
Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M. Surgical treatment for carcinoma of the thoracic esophagus with major involvement in the neck or upper mediastinum. J Surg Oncol 1998; 67:6-10. [PMID: 9457249 DOI: 10.1002/(sici)1096-9098(199801)67:1<6::aid-jso2>3.0.co;2-f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES In carcinoma of the thoracic esophagus, most surgeons consider that esophagectomy is contraindicated in patients with clinical evidence of major extraesophageal involvement in the lower neck or peritracheal regions. However, metastases to these regions are commonly found even in early phases of carcinoma invasion. With recent progress in preoperative assessment, operative technique and adjuvant therapy, esophagectomy could possibly benefit appropriately selected patients. METHODS We retrospectively analyzed results in 42 patients who had major involvement in the neck or upper mediastinum and who underwent esophagectomy with systematic lymph node dissection. We operated upon patients unless lesions were assessed as definitely unresectable. Preoperatively, 32 had enlarged peritracheal nodes greater than 15 mm in diameter on computed tomography, 18 had hard unmobile tumors in the lower neck, 9 had recurrent laryngeal nerve palsy, and 10 had findings suggestive of tracheal invasion. Preoperative radiotherapy and/or chemotherapy was given to 32 low-risk patients. RESULTS The hospital mortality rate was 4%. Bowel reconstruction was completed in all cases. No macroscopically recognizable lesion remained after operation in 35 patients. Eight patients were alive 5 years after esophagectomy, including 2 who had had tracheal invasion and 1 with recurrent nerve palsy. The cumulative 5-year survival was 38%. CONCLUSIONS Evidence of major involvement of the neck and/or upper mediastinum does not always contraindicate resection. Aggressive esophagectomy combined with perioperative adjuvant therapy yielded acceptable palliation and occasional cure in cases with technically resectable lesions.
Collapse
Affiliation(s)
- T Matsubara
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|