INCIDENCE OF RECURRENT LARYNGEAL NERVE PALSY IN CERVICAL ANASTOMOSIS AFTER ESOPHAGECTOMY FOR CARCINOMA ESOPHAGUS

Objective: To study the incidence of Recurrent Laryngeal Nerve Palsy (RLNP) in cervical anastomosis after esophagectomy for carcinoma of the esophagus. Study Design: Prospective observational study. Place and Duration of Study: Military Hospital’s Thoracic surgery departments, Combined Military Hospital Rawalpindi, Combined Military Hospital Lahore and Combined Military Hospital Multan, from Jan 2010 to Sep 2020. Methodology: Designated proformas were used to collect data. Histopathologically proven, operable cases of carcinoma esophagus with normal phonation were included, all of which underwent cervical anastomosis. All cases of benign pathologies and per-operative macroscopically advanced loco-regional disease were excluded. Recurrent laryngeal nerve (RLN) was identified in all cases and follow-up of 6 months for recovery period was executed. Results: 220 cases were included out of which 121 (55%) were males while 99 (45%) females. The age range was 14-81 years (mean is 38.7 ± 16.78). Out of 29 (13.6%) cases underwent minimally invasive esophagectomy (MIE) while thoracophreno laparotomy was performed in 100 (45.4%) cases, McKeown in 46 (20.9%) and Trans-hiatal esophagectomy (THE) in 45 (20.4%) patients. Recurrent Laryngeal Nerve Palsy was found in 19 patients (8.6%), tracheal injury in 3 (1.3%) and bronchial injury in 1 (0.4%) patient. Recurrent Laryngeal Nerve Palsy was transient in 14 cases and permanent damage persisted in 5 patients. Conclusion: Recurrent Laryngeal Nerve Palsy after esophagectomy is related to increased morbidity due to respiratory complications. With Sharp dissection technique, adequate surgical skill and equipment, the incidence of Recurrent Laryngeal Nerve Palsy can be decreased. In our study, it is less............

Bilateral Recurrent Laryngeal Nerve Palsy following Total Thyroidectomy in Triple A Syndrome, an Unexpected but Critical Complication

Introduction. Triple “A” syndrome (TAS) is a rare autosomal recessive disorder that presents in childhood with achalasia cardia, alacrima, ACTH-resistant adrenal insufficiency, with sensorimotor and autonomic polyneuropathy developing later in the course of the disease. Case Presentation. An adult white male affected by this syndrome underwent an uneventful total thyroidectomy for malignancy and suffered delayed bilateral recurrent laryngeal nerve palsy in the early postoperative hours. The palsy spontaneously resolved after a five-week course. Conclusion. Given the rarity of this severe condition and the absence of surgical or medical causes identifiable, there is possibility that it is the neurological involvement caused by TAS that predisposed the patient to this adverse outcome, precipitated by standard manipulations during surgery.

Outcomes of esophagectomy for patients with esophageal squamous cell carcinoma accompanied by recurrent laryngeal nerve palsy at diagnosis

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.

213 CLINICAL SIGNIFICANCE OF ROBOTIC ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER

Nowadays many patients with esophageal cancer are treated with thoracoscopic esophagectomy (TE) with precise mediastinal lymphadenectomy as a minimally invasive esophagectomy (MIE) in Japan. These advanced endoscopic surgeries are believed to contribute to early postoperative recovery. More recently robotic esophagectomy (RE) appeared attractively. To date, however, there has been a very limited number of comparison studies to verify the benefits of RE for esophageal cancer, especially in Japan where squamous cell carcinoma is predominant. Methods We retrospectively compared the short-term outcomes between TE (n = 43) and RE (n = 19) which were performed in our institution between 2018 and 2020 to verify the clinical significance of RE. Preoperative background factors of the patients compared were almost identical between the two groups. Results The operative time was longer in the RE group than in the OE group, whereas blood loss was equivalent between the two groups. There was no significant differences in the number of dissected mediastinal lymph nodes between the TE and RE groups (33+/−15 vs 29+/−11). The incidence of postoperative recurrent laryngeal nerve palsy was markedly less in the RE group than the TE group (5.2% vs. 18.6%). Moreover, the incidence of postoperative pneumonia also tended to be less in the RE group than in the TE group (5.2% vs. 11.6%). There were no operative mortality in the two groups. Conclusion Our results suggest that RE is comparable with conventional TE in terms of short-term outcome after surgery, and beneficial to technically reduce the recurrent laryngeal nerve palsy as a promising MIE.

The circumstances in which recurrent laryngeal nerve palsy occurs after surgery for benign thyroid disease: a retrospective study of 1026 patients

Objective To evaluate the circumstances in which recurrent laryngeal nerve palsy occurs after thyroid surgery. Methods This study assessed 1026 patients who underwent surgery for benign thyroid disease over a seven-year period in a retrospective, single-centre study. Results With a total of 1835 recurrent laryngeal nerves at risk, there were 38 cases (2.07 per cent) of transient recurrent laryngeal nerve palsy and 8 (0.44 per cent) of permanent recurrent laryngeal nerve palsy. No explanation was found for 10 of the 46 cases of recurrent laryngeal nerve palsy. Among the 38 other cases, the probable causes included poor identification of the recurrent laryngeal nerve during surgery, involuntary resection of the nerve and several other factors. Conclusion Apart from accidental resection of the recurrent laryngeal nerve during thyroid surgery, the causes of post-operative recurrent laryngeal nerve palsy are often unclear and likely multifactorial. Poor identification of the recurrent laryngeal nerve during surgery is still the main cause of post-operative recurrent laryngeal nerve palsy, even when intra-operative neuromonitoring is used.