High risk of unilateral recurrent laryngeal nerve paralysis after esophagectomy using cervical anastomosis

• Published in: European archives of oto-rhino-laryngology Vol. 268; no. 11; pp. 1605 - 1610
• Main Authors: Pertl, L., Zacherl, J., Mancusi, G., Gächter, J. N., Asari, R., Schoppmann, S., Bigenzahn, W., Schneider-Stickler, B.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.11.2011; Springer
• Subjects: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical - adverse effects; Austria - epidemiology; Biological and medical sciences; Deglutition; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - methods; Esophagus - physiopathology; Esophagus - surgery; Follow-Up Studies; Head and Neck Surgery; Humans; Incidence; Laryngology; Laryngoscopy - methods; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neck - surgery; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neurosurgery; Non tumoral diseases; Otorhinolaryngology; Otorhinolaryngology. Stomatology; Retrospective Studies; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Vocal Cord Paralysis - diagnosis; Vocal Cord Paralysis - epidemiology; Vocal Cord Paralysis - etiology; Austria; Recurrent nerve paralysis; Hoarseness; Esophageal cancer; Voice disorder; High risk; Motor system disorder; Esophageal disease; ENT; Language disorder; Esophagus cancer; Surgery; ENT disease; Dysphonia; Larynx disease; Neck; Paralysis; Neurological disorder; Nervous system diseases; Esophagectomy; Malignant tumor; Esophagus; Communication disorder; Treatment; Unilateral; Digestive diseases; Cancer; Recurrent laryngeal nerve
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-011-1679-7

The goal of this study was to estimate the incidence of temporary and permanent unilateral recurrent laryngeal nerve paralysis (URLNP) after esophagectomies with cervical anastomosis and to determine the impact of surgical technique, tumor type, tumor localization and age on the incidence of URLNP. From March 2002 to November 2009, 84 patients underwent a laryngoscopical evaluation before and after esophagectomy with cervical anastomosis prospectively. If the postoperative URLNP recovered within 6 months, the paresis was classified as transient; if not, it was defined as permanent. The results indicate that the overall incidence of postoperative URLNP was 50% (42/84). Twenty-four of the 84 patients (28.6%) showed a transient URLNP. A permanent URLNP was observed in 9 of the 84 patients (10.7%). The remaining 9 of the 84 patients (10.7%) were categorized as paresis with unknown clinical outcome due to missing follow-up. There were significantly more postoperative URLNPs in the group operated by transthoracic esophagectomy than by transhiatal esophagectomy ( p  < 0.001). Multifocal tumors and those localized suprabifurcational showed a higher incidence of postoperative URLNP than unifocal lesions with infrabifurcational localization ( p  = 0.046). Histological type of tumor and patients’ age had no impact on URLNP. The high incidence of URLNP in our study underlines the high risk of URLNP after esophagectomy with cervical anastomosis, and consequently the importance of routine laryngoscopic pre- and postoperative evaluation of the vocal fold motility.