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Okamoto K, Takamura H, Nagayama T, Sannomiya Y, Hashimoto A, Nishiki H, Kaida D, Miyata T, Tsuji T, Fujita H, Kinami S, Ninomiya I, Inaki N. Usefulness of Perioperative Nutritional Therapy with the Glutamine/Arginine/Calcium β-Hydroxy-β-Methylbutyrate Product in Esophageal Cancer Surgery: A Single-Center Retrospective Study. Nutrients 2024; 16:2126. [PMID: 38999874 PMCID: PMC11243618 DOI: 10.3390/nu16132126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
A useful perioperative nutritional therapy for highly invasive esophageal cancer surgical cases needs to be developed. We clarified the usefulness of amino-acid-enriched nutritional therapy using glutamine (Gln)/arginine (Arg)/calcium β-hydroxy-β-methylbutyrate (HMB) products on the short-term postoperative outcomes of minimally invasive esophagectomy for esophageal cancer. Altogether, 114 patients (Gln/Arg/HMB group) received perioperative nutritional therapy with Gln/Arg/HMB products, and we retrospectively investigated the change in nutritional parameters including skeletal muscle mass, occurrence of postoperative complications, and short-term postoperative outcomes in this group. The results were compared between the Gln/Arg/HMB and control groups (79 patients not receiving the Gln/Arg/HMB products). The incidence of all postoperative complications, sputum expectoration disorder, and pleural effusion of grade ≥ III was significantly lower in the Gln/Arg/HMB group (62.0% vs. 38.6%, p = 0.001; 44.3% vs. 28.1%, p = 0.020; 27.8% vs. 13.2%, p = 0.011, respectively). The psoas muscle area and postoperative body weight were significantly higher at 1 month and 1 year after surgery in the Gln/Arg/HMB group than in the control group (93.5% vs. 99.9%, p < 0.001; 92.0% vs. 95.4%, p = 0.006). Perioperative amino-acid-enriched nutritional therapy may improve the short-term postoperative outcomes, nutritional status, and skeletal muscle mass of esophageal cancer surgical patients.
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Affiliation(s)
- Koichi Okamoto
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8641, Ishikawa, Japan; (T.T.); (N.I.)
| | - Hiroyuki Takamura
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Taigo Nagayama
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Yuta Sannomiya
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Akifumi Hashimoto
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Hisashi Nishiki
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Daisuke Kaida
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Takashi Miyata
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Toshikatsu Tsuji
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8641, Ishikawa, Japan; (T.T.); (N.I.)
| | - Hideto Fujita
- Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinadamachi, Kahoku 920-0293, Ishikawa, Japan; (H.T.); (T.N.); (Y.S.); (A.H.); (H.N.); (D.K.); (T.M.); (H.F.)
| | - Shinichi Kinami
- Department of General and Digestive Surgery, Kanazawa Medical University Himi Municipal Hospital, Himi, Toyama 935-8531, Japan;
| | - Itasu Ninomiya
- Department of Surgery, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-0846, Japan;
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa 920-8641, Ishikawa, Japan; (T.T.); (N.I.)
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Ao Y, Zhong L, Luo K, Li S, Zhang X, Shao L, Lin X, Hu Y. Comparison of Postoperative Outcomes Between Near-Infrared Fluorescent Imaging-Guided Mediastinal Lymphadenectomy and Conventional Surgery for Esophageal Cancer. Ann Surg Oncol 2024; 31:3830-3838. [PMID: 38245649 DOI: 10.1245/s10434-024-14937-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND The study aimed to evaluate the efficacy of using near-infrared fluorescent imaging (NIRF) imaging with indocyanine green as an intraoperative tool for achieving complete mediastinal lymph node (LN) resection. PATIENTS AND METHODS Between September 2019 and July 2021, patients with potential for esophagectomy due to middle and lower thoracic esophageal cancer were enrolled in this study. All patients were scheduled for NIRF-guided mediastinal lymphadenectomy during esophageal cancer surgery and were appropriately assigned to the NIRF group. Patients who underwent esophagectomy between September 2017 and September 2019 were assigned to the historical control group upon satisfying the inclusion/exclusion criteria. Surgical outcomes and the number of removed LNs were compared between the two groups using 1:1 propensity score matching. RESULTS Of 67 eligible patients, 59 patients were included in the NIRF group after postsurgical exclusions. The operative time was significantly shorter in the NIRF group than in the historical control group [180 (140-420) min versus 202 (137-338) min; P < 0.001]. The incidence of postoperative chylothorax and hoarseness were significantly lower in the NIRF group than in the historical control group (0% versus 10.2 %; P = 0.036, 3.4% versus 13.6%; P = 0.047). The number of dissected total LNs, mediastinal LNs, and negative LNs was significantly larger in the NIRF group than in the historical control group. The number of overall metastatic LNs and abdominal LNs was comparable between the two groups. CONCLUSIONS NIRF imaging can assist in the thorough and complete mediastinal LNs dissections without increasing complications in patients undergoing esophagectomy.
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Affiliation(s)
- Yong Ao
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - LeQi Zhong
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - KongJia Luo
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
- Guangdong Esophageal Cancer Research Institute, Guangzhou, China
| | - ShiNing Li
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - Xin Zhang
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - Lu Shao
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - XiaoDan Lin
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - Yi Hu
- Department of Thoracic Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China.
- Guangdong Esophageal Cancer Research Institute, Guangzhou, China.
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Brunet A, Rovira A, Quer M, Sanabria A, Guntinas-Lichius O, Zafereo M, Hartl DM, Coca-Pelaz A, Shaha AR, Marie JP, Vander Poorten V, Piazza C, Kowalski LP, Randolph GW, Shah JP, Rinaldo A, Simo R. Recurrent Laryngeal Nerve Intraoperative Neuromonitoring Indications in Non-Thyroid and Non-Parathyroid Surgery. J Clin Med 2024; 13:2221. [PMID: 38673494 PMCID: PMC11050584 DOI: 10.3390/jcm13082221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/26/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Introperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is a well-established technique to aid in thyroid/parathyroid surgery. However, there is little evidence to support its use in non-thyroid or non-parathyroid surgery. The aim of this paper was to review the current evidence regarding the use of IONM in non-thyroid/non-parathyroid surgery in the head and neck and thorax. A literature search was performed from their inception up to January 2024, including the term "recurrent laryngeal nerve monitoring". IONM in non-thyroid/non-parathyroid surgery has mainly been previously described in oesophageal surgery and in tracheal resections. However, there is little published evidence on the role of IONM with other resections in the vicinity of the RLN. Current evidence is low-level for the use of RLN IONM in non-thyroid/non-parathyroid surgery. However, clinicians should consider its use in surgery for pathologies where the RLN is exposed and could be injured.
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Affiliation(s)
- Aina Brunet
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Universitari Bellvitge, Universitat de Barcelona, 08907 Barcelona, Spain
- Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Aleix Rovira
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK (R.S.)
| | - Miquel Quer
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia, Hospital Universitario San Vicente Fundación, CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin 1226, Colombia
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Head and Neck Surgery, Jena University Hospital, 07747 Jena, Germany
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dana M. Hartl
- Thyroid Surgery Unit, Department of Otorhinolaryngology Head and Neck Surgery, Institute Gustave Roussy, 94805 Paris, France;
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, 33011 Oviedo, Spain
| | - Ashok R. Shaha
- Department of Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, Medical College, Cornell University, New York, NY 10065, USA
| | - Jean-Paul Marie
- Department of Otorhinolaryngology Head and Neck Surgery, Institute of Biomedical Research, University Hospital Rouen, 76000 Rouen, France;
| | - Vincent Vander Poorten
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Cesare Piazza
- Department of Otorhinolaryngology Head and Neck Surgery, ASST Spedali Civili of Brescha, School of Medicine, University of Brescia, 25123 Brescia, Italy
| | - Luiz P. Kowalski
- Department of Otorhinolaryngology Head and Neck Surgery, A.C. Camargo Cancer Center, Faculty of Medicine, University of Sao Paulo, São Paulo 03828-000, Brazil;
| | - Gregory W. Randolph
- Department of Otorhinolaryngology, Division of Thyroid and Parathyroid Endocrine Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | - Jatin P. Shah
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, Weil Medical College, Cornell University, New York, NY 10065, USA
| | | | - Ricard Simo
- Department of Otorhinolaryngology, Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK (R.S.)
- King’s College London, London SE5 8AF, UK
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Zhu Y, Xu S, Teng X, Zhao R, Peng L, Fang Q, Xiao W, Jiang Z, Li Y, Luo X, Han Y, Daiko H, Leng X. Refining postoperative monitoring of recurrent laryngeal nerve injury in esophagectomy patients through transcutaneous laryngeal ultrasonography. Esophagus 2024; 21:141-149. [PMID: 38133841 DOI: 10.1007/s10388-023-01036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Recurrent laryngeal nerve injury (RLNI) leading to vocal cord paralysis (VCP) is a significant complication following minimally invasive esophagectomy (MIE) with upper mediastinal lymphadenectomy. Transcutaneous laryngeal ultrasonography (TLUSG) has emerged as a non-invasive alternative to endoscopic examination for evaluating vocal cord function. Our study aimed to assess the diagnostic value of TLUSG in detecting RLNI by evaluating vocal cord movement after MIE. METHODS This retrospective study examined 96 patients with esophageal cancer who underwent MIE between January 2021 and December 2022, using both TLUSG and endoscopy. RESULTS VCP was observed in 36 out of 96 patients (37.5%). The incidence of RLNI was significantly higher on the left side than the right (29.2% vs. 5.2%, P < 0.001). Postoperative TLUSG showed a sensitivity and specificity of 88.5% (31/35) and 86.5% (45/52), respectively, with an AUC of 0.869 (P < 0.001, 95% CI 0.787-0.952). The percentage agreement between TLUSG and endoscopy in assessing VCP was 87.4% (κ = 0.743). CONCLUSIONS TLUSG is a highly effective screening tool for VCP, given its high sensitivity and specificity. This can potentially eliminate the need for unnecessary endoscopies in about 80% of patients who have undergone MIE.
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Affiliation(s)
- Yi Zhu
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shanling Xu
- Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xiangnan Teng
- Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Rui Zhao
- Department of Endoscopy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Wenguang Xiao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Zhuolin Jiang
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yanjie Li
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xinyi Luo
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China.
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
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Song S, Shen C, Hu Y, He Y, Yuan Y, Xu Y. Application of Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy in Individualized Treatment of Esophageal Cancer. Biomedicines 2023; 11:2750. [PMID: 37893123 PMCID: PMC10603894 DOI: 10.3390/biomedicines11102750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Surgery is a crucial treatment option for patients with resectable esophageal cancer. The emergence of minimally invasive esophageal techniques has led to the popularity of video-assisted thoracoscopic esophagectomy, which has proven to be more advantageous than traditional thoracotomy. However, some patients with esophageal cancer may not benefit from this procedure. Individualized treatment plans may be necessary for patients with varying conditions and tolerances to anesthesia, making conventional surgical methods unsuitable. Inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) has emerged as a promising treatment option for esophageal cancer because it does not require one-lung ventilation, reduces postoperative complications, and expands surgical indications. This technique also provides surgical opportunities for patients with impaired pulmonary function or thoracic lesions. It is crucial to have a comprehensive understanding of the advancements and limitations of IVMTE to tailor treatment plans and improve outcomes in patients with esophageal cancer. Understanding the advantages and limitations of this surgical method will help specific patients with esophageal cancer. We conducted a thorough review of the relevant literature to examine the importance of IVMTE for individualized treatment of this disease.
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Affiliation(s)
- Shangqi Song
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yazhou He
- Usher Institute of Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yuyang Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
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Cabañero A, Cavestany C, Fra S, Muñoz GM, Caballero U, Moreno N. Surgical evaluation of station 4L in patients with lung cancer: the Ugly Duckling. J Thorac Dis 2023; 15:14-16. [PMID: 36794136 PMCID: PMC9922612 DOI: 10.21037/jtd-22-1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
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Application of Intraoperative Neuromonitoring (IONM) of the Recurrent Laryngeal Nerve during Esophagectomy: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12020565. [PMID: 36675495 PMCID: PMC9860817 DOI: 10.3390/jcm12020565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/24/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND recurrent laryngeal nerve palsy (RLNP) is a common and severe complication of esophagectomy in esophageal cancer (EC). Several studies explored the application of intraoperative neuromonitoring (IONM) in esophagectomy to prevent RLNP. The purpose of this study was to conduct a systematic review and meta-analysis to evaluate the value of IONM in esophagectomy for EC. METHODS an electronic of the literature using Google Scholar, PubMed, Embase, and Web of Science (data up to October 2022) was conducted and screened to compare IONM-assisted and conventional non-IONM-assisted esophagectomy. RLNP, the number of mediastinal lymph nodes (LN) dissected, aspiration, pneumonia, chylothorax, anastomotic leakage, the number of total LN dissected, postoperative hospital stay and total operation time were evaluated using Review Manager 5.4.1. RESULT ten studies were ultimately included, with a total of 949 patients from one randomized controlled trial and nine retrospective case-control studies in the meta-analysis. The present study demonstrated that IONM reduced the incidence of RLNP(Odds Ratio (OR) 0.37, 95% Confidence Interval (CI) 0.26-0.52) and pneumonia (OR 0.58, 95%CI 0.41-0.82) and was associated with more mediastinal LN dissected (Weighted Mean Difference (WMD) 4.75, 95%CI 3.02-6.48) and total mediastinal LN dissected (WMD 5.47, 95%CI 0.39-10.56). In addition, IONM does not increase the incidence of aspiration (OR 0.4, 95%CI 0.07-2.51), chylothorax (OR 0.55, 95%CI 0.17-1.76), and anastomotic leakage (OR 0.78, 95%CI 0.48-1.27) and does not increase the total operative time (WMD -12.33, 95%CI -33.94-9.28) or postoperative hospital stay (WMD -2.07 95%CI -6.61-2.46) after esophagectomy. CONCLUSION IONM showed advantages for preventing RLNP and pneumonia and was associated with more mediastinal and total LN dissected in esophagectomy. IONM should be recommended for esophagectomy.
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