Clinical significance of recurrent laryngeal nerve exposure during esophagogastric anastomosis of the neck
Tóm tắt
To investigate the clinical value in a comparison between intraoperative exposure and non-exposure of the recurrent laryngeal nerve (RLN) of the neck during left neck esophagogastric anastomosis following resection of carcinomas of the middle and inferior-segment esophagus. From January 2003 to April 2009, 237 patients were selected to undergo resection of esophageal squamous carcinoma via posteroexternal incision of the left chest plus gastroesophageal anastomosis at the left neck incision. The 237 cases were divided into 2 groups: 115 of the total cases were in group A (the study group), cases of resections with neck RLN exposure. Of the patients in this group, 64 were male and 51 female, with a mean age of 49 ranging from 31 to 73 years. Another 122 cases were in group B (the control group), cases of resections without neck RLN exposure. In this group, 51 of the patients were male and 71 female, with a mean age of 45 ranging from 33 to 75 years. In the 2 groups, there were 9 cases in total with symptoms induced by RLN injury. Hoarseness, choking cough when drinking, and difficult expectoration were found in 1 of the cases (1/115) in group A (0.087%), while there were 8 cases (8/122) presenting with these symptoms in group B (6.5%). There is statistical significance in the diff erences of RLN injury between the 2 groups (P < 0.05). Analysis of study cases of esophageal carcinoma resection with left-neck esophagogastric anastomosis in the 2 groups indicated that the exposure of the RLN in group A resulted in an obviously lower rate of neck RLN injury after the surgery, compared to group B, where the RLN was not exposed. Exposure can lead to the avoidance of complications induced by RLN injury, such as dysarthria and choking cough when eating. As a result, satisfactory expectoration, which would diminish the incidence of pulmonary complications, can be reached allowing the patients to recover as early as possible. The results of our study suggest that the exposure of the RLN during the left-neck esophagogastric anastomosis has significant clinical value, and that this approach can be recommended with confidence.
Tài liệu tham khảo
Huang XM, Qin WH, Sun YE. Modern Thoracic Surgery. Beijing: People’s Military Medical Press 1997; 520-521 (Chinese).
Fu JH. Analysis of 85 cases with residue of incisal margin after surgery of esophageal carcinoma. Ai Zheng 1995; 14: 124–125 (Chinese).
Wang YM, Zang YL, Zhang GP, et al. Correlation factor of positive metastasis of incisal margin after resection of esophageal carcinoma. Zhonghua Xinxiong Xueguanwaike Zazhi 1999; 15: 240–241 (Chinese).
Chen MY, Shao FF, Chen YH. Reoperation of intrathoracic tomal carcinoma after surgery of esophageal carcinoma. Zhonghua Xinxiongxueguan Waike Zazhi 2001; 17: 77–78 (Chinese).
Tam PC, Siu KTS, Cheung HC, et al. Local recurrence after subtotal esophagectomy for squamous cell carcinoma. Ann Surg 1995; 169: 634–640.
Lin XS, Wu X, Chen BG, et al. Significance of stump cancer in the specimen of esophageal incisal margin. Zhonghua Waike Zazhi 1985; 23: 30–32 (Chinese).
John DU, Rschel MD. Esophagogastrostomy Anastomotic Leaks Complicating Esophagectomy. A Review. Am J Surg 1995; 169: 634–640.
Chen SD. Experience of 300 cases undergoing resection of thoracic esophageal carcinoma with left-neck oesophagogastric anastomosis. Zhongguo Meitangongye Yixuezazhi 1999; 2: 234 (Chinese).
Zieren Hu, Muller JM, Pichlnaier H. Prospective randomized study of one or two layer anastomosis following esophageal resection and cervical esophagogastrostomy. Br J Surg 1993; 80: 608–611.
Zhu XM, Yao W, Zhang ZX, et al. Avoidance of recurrent laryngeal nerve injury during the manipulation in the neck of esophageal cancer resection. Zhongguo Zhongliu Linchuang 1994; 21: 612 (Chinese).
Wang FS. Postoperative Complication of Esophageal Carcinoma and Carcinoma of Gastric Cardia. In: Wang SJ, Wang QZ eds. Esophageal Carcinoma and Carcinoma of Gastric Cardia. Beijing: People’s Medical Publishing House. 2008; 257–279 (Chinese).
Xu JL, Shao HF, Gao ZR, et al. Application and evaluation of neck reconstruction after resection of thoracic esophageal carcinoma. Zhonghua Zhongliu Zazhi 1996; 18: 45 (Chinese).
Wei GQ. Reconstruction of the Esophagus. In: Wang QZ eds. Surgery of the Esophagus, Beijing, People’s Medical Publishing House. 2005; 583–645 (Chinese).
Wei GQ, Shao HF, Gao ZR, et al. Analysis of complications in neck reconstruction after resection of esophageal cancer. Zhonghua Xiongxinxueguan Waike Zazhi 1991; 7: 168 (Chinese).
Xu YL, Guo ZY, Chen JY, et al. Analysis of 15 cases with injury of recurrent laryngeal nerve after surgery of esophageal carcinoma. Zhonghua Xiongxinxueguan Waike Zazhi 1993; 9: 103 (Chinese).
Yan TS, Zhang DW, Zhang RG, et al. Surgical results of neck reconstruction in esophageal cancer located at and above the high mid-thoracic segment—a report of 414 cases. Zhonghua Zhongliu Zazhi 1994; 16: 29 (Chinese).
Mori S, Ishida K. Exsensive Lymphadenectomy in thoracic esophageal carcinoma. Gan-To-Kagaku-Ryono 1989; 16: 1044.
Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2004; 78: 1l70–1176.
Wang SC, Di J, Mi N. Analysis of 13 cases with injury of the recurrent laryngeal nerve. Zhongguo Wuzhenxue Zazhi 2004; 18: 766–767 (Chinese).
Shao LF, Li ZC, Liu SX, et al. Surgical treatment of 3155 cases with Esophageal Carcinoma and Carcinoma of Gastric Cardia. Zhonghua Waike Zazhi 1982; 20: l9 (Chinese).
Zhi HX, Cao JF, Zhou MH, et al. Prevention of bronchopneumonia after excision of carcinoma of esophago cardia. Henan Zhongliuxue Zazhi 1995; 8: 109 (Chinese).
Jatzko GR, Lisborg PH, Muller MG, et al. Recurrent nerve palsy after thyroid operations principal nerve identification and literature review. Surgery 1994; 115: 139–144.
Wang QH, Shi ZP. Studies of applied anatomy on blood supply in the vagus nerve and recurrent laryngeal nerve. Linchuang Yingyongjiepouxue Zazhi 1985; 3: 144 (Chinese).
Zhang HL, Chen RX, eds. Oncology Nursing. Tianjin: Tianjin Science and Technology Press 2002; 342 (Chinese).