Esophageal Cancer
Conditions
Keywords
Esophageal Cancer, Minimally invasive surgery, Recurrent laryngeal nerves, Intraoperative nerve monitoring
Brief summary
The clinical value of intraoperative nerve monitoring (IONM) in thoracoscopic esophagectomy remains uncertain. The aim of this randomized clinical trial was to compare the impact of RLN visualization versus IONM on their morbidity following thoracoscopic esophagectomy.
Detailed description
Recurrent laryngeal nerves (RLN) lymph nodes are the most common metastatic areas in esophageal squamous carcinoma. It is a clinical challenge to reduce high incidence of RLN injury rate result from routine dissection of RLN lymph nodes. Thoracoscopic approach may provide a clear operative field and potentially less invasive surgery. But there are still high RLN injury rate only depending on visualization of thoracoscopy. The use of intraoperative nerve monitoring (IONM) was shown very helpful to identify the RLN and associated with a reduction of RLN injury rate in thyroidectomy. However, there is no solid clinical evidence about the effectiveness of utility of IONM in thoracoscopic esophagectomy. Thus, the aim of this randomized clinical trial was to compare the impact of RLN visualization versus IONM on their morbidity following thoracoscopic esophagectomy.
Interventions
PROCEDUREintraoperative nerve monitoring
Intraoperative bilateral recurrent laryngeal nerve monitoring was utilized during dissection of right and left recurrent laryngeal nerve lymph nodes.
Sponsors
Tianjin Medical University Cancer Institute and Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
Yes
Inclusion criteria
1. Histologically proven primary intrathoracic middle and lower esophageal squamous cell carcinoma and will undergo McKeown MIE and bilateral RLN lymph ndoe dissection. 2. No superclavicular lymph node metastasis after preoperative examination. 3. No contraindication for esophagectomy. 4. Expected surgical R0 resection.
Exclusion criteria
1. Pre-existed vocal cord dysfunction. 2. Thorax pleural adhesion rendering minimal invasive approach unfeasible. 3. Gastric tube cannot be used for reconstruction. 4. Combined with hemorrhagic disease. 5. Psychiatric patients. 6. Inability to undergo curative resection and/or follow-up.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of the recurrent laryngeal nerve injury | Till 6 months postoperatively | The vocal cord function will be assessed by an experienced otolaryngologist using a laryngoscope on 1st postoperative day.RLN palsy will be classified according to the following variables: site (unilateral versus bilateral); duration (temporary \[i.e., recovering within 6 months\] versus permanent \[i.e. not recovering within 6 months\])postoperatively. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of nodes removed along the right and left RLN | The pathological analysis will be finished within 2 weeks. | number of lymph node removed |
| Value of IONM during operation | 1 Day of surgery | — |
| Post esophagectomy pneumonia rate | Duration of hospital stay, an expected average of 2~3 weeks. | — |
| Operation time (thoracic phase) | Intraoperative | — |
Countries
China
Contacts
Primary ContactHongjing Jiang, MD. Ph.D.
Backup ContactZhao Ma, MD. Ph.D.
Outcome results
None listed