BACKGROUND: Although vocal cord paralysis is a well known complication of subtotal oesophagectomy, precise data concerning origin, incidence and associated morbidity are lacking. METHODS: A retrospective study was performed of 241 patients who underwent transhiatal oesophagectomy for carcinoma of the mid/distal oesophagus between 1994 and 1998. Preoperative and postoperative laryngoscopy results were available for 140 patients. RESULTS: There were 109 men and 31 women, of mean age 63 years. Thirty-one patients (22 per cent) with recurrent laryngeal nerve paralysis were identified, three with bilateral and 28 with unilateral dysfunction. Paralysis occurred ipsilateral to the side of the cervical incision in 22 of 28 patients. It was permanent in six patients. The associated morbidity was substantial: pulmonary complications were more common in patients with vocal cord paralysis (12 of 31 versus 26 (24 per cent) of 109), leading to significantly more reintubations, and a significantly prolonged ventilation time and stay in the intensive care unit. CONCLUSION: Although mostly transient, vocal cord paralysis is a frequent complication with significant associated morbidity. In an extended transthoracic resection (including a lymphadenectomy in the aortopulmonary window where the left recurrent laryngeal nerve is at risk) the cervical anastomosis should be made on the left side, to minimize the risk of bilateral vocal cord paralysis.
BACKGROUND: Although vocal cord paralysis is a well known complication of subtotal oesophagectomy, precise data concerning origin, incidence and associated morbidity are lacking. METHODS: A retrospective study was performed of 241 patients who underwent transhiatal oesophagectomy for carcinoma of the mid/distal oesophagus between 1994 and 1998. Preoperative and postoperative laryngoscopy results were available for 140 patients. RESULTS: There were 109 men and 31 women, of mean age 63 years. Thirty-one patients (22 per cent) with recurrent laryngeal nerve paralysis were identified, three with bilateral and 28 with unilateral dysfunction. Paralysis occurred ipsilateral to the side of the cervical incision in 22 of 28 patients. It was permanent in six patients. The associated morbidity was substantial: pulmonary complications were more common in patients with vocal cord paralysis (12 of 31 versus 26 (24 per cent) of 109), leading to significantly more reintubations, and a significantly prolonged ventilation time and stay in the intensive care unit. CONCLUSION: Although mostly transient, vocal cord paralysis is a frequent complication with significant associated morbidity. In an extended transthoracic resection (including a lymphadenectomy in the aortopulmonary window where the left recurrent laryngeal nerve is at risk) the cervical anastomosis should be made on the left side, to minimize the risk of bilateral vocal cord paralysis.
Authors: L Pertl; J Zacherl; G Mancusi; J N Gächter; R Asari; S Schoppmann; W Bigenzahn; B Schneider-Stickler Journal: Eur Arch Otorhinolaryngol Date: 2011-06-25 Impact factor: 2.503
Authors: Nadeem UlNazeer Kawoosa; Abdul Majeed Dar; Mukand Lal Sharma; Abdul Gani Ahangar; Ghulam Nabi Lone; Mohammad Akbar Bhat; Shyam Singh Journal: World J Surg Date: 2011-06 Impact factor: 3.352
Authors: Seung Yeol Lee; Hee-Jung Cheon; Sang Jun Kim; Young Mog Shim; Jae Ill Zo; Ji Hye Hwang Journal: Support Care Cancer Date: 2015-05-31 Impact factor: 3.603
Authors: Grant Sanders; Frederic Borie; Emanuel Husson; Pierre Marie Blanc; Gianluca Di Mauro; Christiano Claus; Bertrand Millat Journal: Surg Endosc Date: 2007-05-04 Impact factor: 4.584