P1.249. Thoracoscopic Esophagectomy With Superior Mediatinal Lymphadenectomy Usiing Intraoperative Nerve Monitoring to Avoid Postoperative Recurrent Laryngeal Nerve Palsy

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – technique Background Esophageal cancer frequently metastasizes to superior mediastinal lymph, necessitating thorough lymphadenectomy. However, the Japanese National Cancer Database reports significantly high rates of recurrent laryngeal nerve palsy in thoracoscopic esophagectomy. To enhance surgical safety, we introduced intraoperative intermittent nerve integrity monitoring (I-NIM) in 2021. We introduced navigation surgery with intraoperative intermittent nerve integrity monitoring (I-NIM) in 2021. We report the the technique and evaluated the impact of I-NIM implementation on postoperative recurrent laryngeal nerve palsy and associated pneumonia. Methods This study included 73 patients who underwent prone thoracoscopic esophageal cancer surgery from November 2021, when I-NIM was introduced, and compared them with 101 patients who underwent the same surgery before I-NIM introduction. The Medtronic NIM-NEURO™ 3.0 system was used for I-NIM, employing the intermittent method with a stimulation probe. We used a standard spiral tube wrapped with the EMG electrode required for NIM 3.0 as an endotracheal tube. Results Among the 101 cases undergoing thoracoscopic esophageal cancer surgery without I-NIM, 12 cases (11.9%) had Clavien-Dindo (CD) classification grade I or higher recurrent laryngeal nerve palsy, and 8 cases (7.9%) had CD grade II or higher. In the 73 cases using I-NIM, CD grade I or higher paralysis occurred in 12 cases (16.4%), and CD grade II or higher occurred in 3 cases (4.1%), showing a reduction. Furthermore, for pneumonia classified as CD grade III or higher, there were 11 cases (10.9%) in the non-I-NIM group and 1 case (1.4%) in the I-NIM group, showing a significant reduction (p=0.02). Conclusion The use of I-NIM during thoracoscopic esophageal cancer surgery may be useful in avoiding recurrent laryngeal nerve palsy and reduce pneumonia caused by recurrent laryngeal nerve palsy.