212 USEFULNESS OF ENDOSCOPIC ESOPHAGECTOMY IN A PRONE POSITION FOR ELDERLY PATIENTS OVER 75 YEARS OLD

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Ken Ito ◽  
Takashi Kamei ◽  
Masahiro Chin ◽  
Motohisa Hagiwara ◽  
Yasuyuki Hara ◽  
...  
Keyword(s):  
Blood Loss ◽  
Nutritional Status ◽  
Prone Position ◽  
Operation Time ◽  
Lateral Position ◽  
Recurrent Nerve ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Number Of Patients ◽  
Recurrent Nerve Paralysis

Abstract   Surgery for esophageal squamous cell carcinoma(ESCC) is one of the most invasive surgery and high mortality rate because operation is centered on the thoracic cavity. Recently, Japan has been facing aging society, and surgery for elderly ESCC patient is increasing. In our hospital, we changed surgical position from left lateral position to prone. In this study, we investigated the surgical outcome and prognosis of ESCC operation in the patients aged ≧ 75. Methods From April 2011 to March 2019, 39 ESCC operations for patients aged ≧ 75 were performed in our hospital. We compered surgical position. We retrospectively examined clinicopathological factors, long-term prognosis, preoperative nutritional status (albmin, neutrophil and lymphocyte ratio), and operation factors (operation time, blood loss, recurrent nerve paralysis, complication, hospital stay). Results Cases in lateral position surgery were 22 and prone position were 17. The median age was 79 vs 79 years old, and the gender ratio was male: female = 16:6/14:3. No significant differences were observed in preoperative nutritional status. The operation time was 458 min vs 501 min (p = 0.126). The blood loss was 318 mL vs 195 mL (p = 0.003). The rate of recurrent nerve paralysis was 42.1% vs 29.4% (p = 0.262). The number of patients in Clavien-Dindo ≧ III complications was 40.9% vs 41.2% (p = 0.987). 3-year OS was 74.7% vs 77.3%, DFS was 78.6% vs 67.7%. Conclusion In ESCC patients aged ≧ 75, surgery in prone position was relatively safe. The blood loss and the recurrent nerve paralysis ware tend to be less. Recurrent nerve monitoring during operation and evaluation of perioperative swallowing function seemed to be the next subject.

PS01.125: SURGICAL APPROACH FOR THE ELDER ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 85-85
Author(s):  
Keitaro Tashiro ◽  
Masaru Kawai ◽  
Sang-Woong Lee ◽  
Ryo Tanaka ◽  
Yoshiro Imai ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Blood Loss ◽  
Open Surgery ◽  
Recurrent Nerve ◽  
Surgical Time ◽  
Nerve Paralysis ◽  
Elder Patients ◽  
Group A ◽  
Group B ◽  
Recurrent Nerve Paralysis

Abstract Background Recently the number of elder patients who have esophageal cancer has been higher in Japan. Because the anesthesia and surgical technique are developing day by day, we can choose surgery as radical therapy for esophageal cancer in elder patients. But the percentage of complication after operation in elder person still should be higher compared to young person. We present the problems and the risks of surgery for elder esophageal cancer in our institution. Methods 61 patients (over 75 years old) who had esophageal cancer underwent esophageal resection from 1998 to 2016 in Osaka Medical College, Japan. We divided these patients to 3 groups: open surgery; Group A, none open surgery (trans hiatal approach); Group B, VATS (Video-Assisted Thoracic Surgery); Group C, and assessed the amount of blood loss and surgical time during operation and the frequency of complication after operation. Results Average age of patient in Group B was significantly higher than other groups (Group A: 78.7 y. o., Group B: 81.3 y. o., Group C: 77.5 y. o.). Surgical time in Group C (526.5 ± 20.7min) was significantly longer than other groups (Group A: 385.5 ± 17.9min, Group B: 297.1 ± 27.4min). Blood loss during operation in Group B tended to be less than other groups (Group A: 575.4 ± 105.4mL, Group B: 320.4 ± 61.0mL, Group C: 317.6 ± 80.3mL). The complication after surgery occurred in 27 patients (44.3%) in whole groups, including pneumonia (48.8%), anastomotic leakage (18.6%), recurrent nerve paralysis (16.3%), empyema (7.0%), ischemia of gastric tube and/or small intestine (4.7%), deep venous thrombosis (4.7%). According to surgical approach, the occurring frequency of pneumonia (Clavien-Dindo classification Grade III and more) after operation in Group A (28.6%) was higher than other group (Group B: 8.3%, Group C: 9.5%), but more recurrent nerve paralysis was occurred in Group C (33.3%) compared to other groups. Conclusion Lung diseases including pneumonia, particularly in elder patient, are one of the most critical and sometimes become a fatal complication after esophageal cancer surgery. VATS seems to be more safe and useful approach in elder esophageal cancer resection, but needs to be care for recurrent nerve paralysis. Disclosure All authors have declared no conflicts of interest.

A hybrid of the prone and left lateral decubitus positions for thoracoscopic esophagectomy with extended LN dissection for esophageal squamous cell carcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 402-402
Author(s):  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Satoru Matsuda ◽  
Yuko Kitagawa
Keyword(s):  
Prone Position ◽  
Clinical Stage ◽  
Operation Time ◽  
Lateral Decubitus Position ◽  
Thoracoscopic Esophagectomy ◽  
Thoracic Esophagus ◽  
Recurrent Nerve ◽  
Number Of Patients ◽  
Left Lateral Decubitus Position ◽  
Lateral Decubitus

402 Background: We first performed thoracoscopic esophagectomy (TE) as a minimally invasive procedure with the left decubitus position in 1996. In 2009 we developed a hybrid of the prone and left lateral decubitus positions for TE with extended LN dissection (Extensive-TE). The patient is fixed with the semi-prone position and we can easily change patient positions from the left lateral decubitus position to the prone position using rotation system of the operation table. The upper mediastinal procedure including lymphadenectomy along the right and left recurrent laryngeal nerve (RLN) is performed with the patient in the left lateral decubitus position, while the middle and lower mediastinal procedures are performed with the patient in the prone position with artificial pneumothorax. Methods: ESCC patients who underwent Extensive-TE between January 2009 and December 2016, were retrospectively reviewed. The patients’ background, surgical outcomes, postoperative complications and recurrence-free survival (RFS) were studied. Results: Primary tumor was located in Cervical esophagus for 2 (1%), the upper-thoracic esophagus for 28 (15%), the mid-thoracic esophagus for 104 (54%) and the lower-thoracic esophagus for 57 (30%). Thenumber of patients classified with pre-treatment clinical stage of 1/2/3/4 was 94(49%)/42(22%)/46(24%)/9(5%), respectively. Eight patients were evaluated as having cM1 disease due to supraclavicular LN metastasis. The number of patients classified with postoperative pathological stage of 0/1/2/3/4 was 5(3%)/70(37%)/48(26%)/49(27%)/19(7%), respectively. The average total operation time was 542.1 and blood loss was 274.2. The incidence of postoperative pneumonia, anastomotic leakage, chylothorax, and recurrent nerve palsy was 17%, 14%, 2%, and 7% respectively. One patient died postoperatively within 90 days after surgery. Three years RFSwith clinical stage of 1/2/3+4 was 91.5%/54.8%/51.9%, respectively. Conclusions: The magnifying effect of thoracoscopy enables us to perform more precise surgery and preserve nerve and vessels. Extensive-TEwith a hybrid position is thought to be feasible and effective methods.

Analysis of Recurrent Nerve Paralysis after Esophagectomy

2015 ◽  
Vol 66 (6) ◽  
pp. 385-390 ◽  
Author(s):  
Makoto Miyamoto ◽  
Tomofumi Sakagami ◽  
Masao Yagi ◽  
Eri Miyata ◽  
Koichi Tomoda ◽  
...  
Keyword(s):  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Recurrent Nerve Paralysis

scholarly journals Experience of 1166 Thyroidectomy without Use of Prophylactic Antibiotic

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Qiang Lu ◽  
Shu-Qin Xie ◽  
Si-Yuan Chen ◽  
Li-Ju Chen ◽  
Qian Qin
Keyword(s):  
Short Duration ◽  
Prophylactic Antibiotic ◽  
Nodular Goiter ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Secondary Hemorrhage ◽  
Single Side ◽  
Perioperative Antibiotics ◽  
Partial Thyroidectomy ◽  
Recurrent Nerve Paralysis

Background. Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events.Aim. We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy.Materials and Methods. 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves’ disease. The mean time of operation was 80.6 ± 4.87 (range: 25–390) min.Results.Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy.Conclusions. Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.

Quantification of vocal fold motion using echography: application to recurrent nerve paralysis detection

2015 ◽  
Author(s):  
Mike-Ely Cohen ◽  
Muriel Lefort ◽  
Héloïse Bergeret-Cassagne ◽  
Siham Hachi ◽  
Ang Li ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Recurrent Nerve Paralysis ◽  
Vocal Fold Motion

PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY.

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 99-99
Author(s):  
Yuki Hirata ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Average Duration ◽  
Oral Intake ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Recurrent Nerve Paralysis ◽  
Reconstruction Group ◽  
Group 1

Abstract Background In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications. Methods We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016. Results The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group. Conclusion In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications. Disclosure All authors have declared no conflicts of interest.

Transcutaneous PCO2 monitoring in the evaluation of hyperventilation of patients with recurrent nerve paralysis

1999 ◽  
Vol 256 (S1) ◽  
pp. S47-S50 ◽  
Author(s):  
H. Miyazaki ◽  
H. Yamashita ◽  
T. Masuda ◽  
T. Yamamoto ◽  
S. Komiyama
Keyword(s):  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Pco2 Monitoring ◽  
Recurrent Nerve Paralysis

scholarly journals A Case Report of Temporary Recurrent Nerve Paralysis after Resection of Big Cervical Anterior Osteophyte

2011 ◽  
Vol 60 (1) ◽  
pp. 101-104
Author(s):  
Kenta Momii ◽  
Kazutoshi Nakaie ◽  
Jyunya Ogata ◽  
Shinichi Fukumoto ◽  
Ryuichi Taen
Keyword(s):  
Case Report ◽  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Recurrent Nerve Paralysis

Recurrent Laryngeal Nerve Section for Spastic Dysphonia

1976 ◽  
Vol 85 (4) ◽  
pp. 451-459 ◽  
Author(s):  
Herbert H. Dedo
Keyword(s):  
Vocal Cord ◽  
Speech Therapy ◽  
Clinical Observation ◽  
Recurrent Nerve ◽  
Nerve Section ◽  
Nerve Paralysis ◽  
The Past ◽  
Vocal Quality ◽  
Recurrent Nerve Paralysis

Spastic dysphonia is a severe vocal disability in which a person speaks with excessively adducted vocal cords. The resulting weak phonation sounds tight, as if he were being strangled, and has also been described as laryngeal stutter. It is often accompanied by face and neck grimaces. In the past it has been regarded as psychoneurotic in origin and treated with speech therapy and psychotherapy with disappointing results. Because of laboratory and clinical observation that recurrent nerve paralysis retracts the involved vocal cord from the midline, it was proposed that deliberate section of the recurrent nerve would improve the vocal quality of patients with spastic dysphonia. In 34 patients the recurrent nerve was sectioned after Xylocaine® temporary paralysis showed significant improvement in vocal quality. Several patients have been advised against this operation because of the type of voice they developed with one vocal cord temporarily paralyzed. With nerve section plus postoperative speech therapy, approximately half of the patients have returned close to a “normal” but soft phonatory voice. The rest had varying degrees of improvement, but all, so far, have been pleased with the improvement in ease and quality of phonation and reduction or elimination of face and neck grimaces. Two men have a breathy component in their phonatory voices, and one woman has variable pitch.

Effects of a computer‐based voice modification device for a speaker with recurrent nerve paralysis

1999 ◽  
Vol 106 (4) ◽  
pp. 2247-2247
Author(s):  
Noriko Kobayashi ◽  
Hajime Hirose ◽  
Kenji Matsui ◽  
Noriyo Hara
Keyword(s):  
Recurrent Nerve ◽  
Nerve Paralysis ◽  
Computer Based ◽  
Recurrent Nerve Paralysis
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