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Vocal cord paralysis after subtotal oesophagectomy
J B Hulscher1, J W van Sandick, P P Devriese
1Department of Surgery, Academic Medical Center/University of Amsterdam, The Netherlands.
The British Journal of Surgery
|December 14, 1999
Summary
Vocal cord paralysis is a frequent complication after oesophagectomy, often causing significant morbidity. Minimizing risk involves careful surgical technique, especially during transthoracic resections.
Area of Science:
- Surgical Oncology
- Otorhinolaryngology
- Thoracic Surgery
Background:
- Vocal cord paralysis is a known complication of subtotal oesophagectomy.
- Precise data on its origin, incidence, and morbidity are limited.
Purpose of the Study:
- To determine the incidence and morbidity of vocal cord paralysis following transhiatal oesophagectomy.
- To identify risk factors and suggest preventive measures.
Main Methods:
- Retrospective study of 241 patients undergoing transhiatal oesophagectomy for esophageal carcinoma (1994-1998).
- Preoperative and postoperative laryngoscopy data analyzed for 140 patients.
Main Results:
- 22% of patients (31/140) developed recurrent laryngeal nerve paralysis, mostly unilateral and ipsilateral to the cervical incision.
- Paralysis was permanent in 6 patients.
- Vocal cord paralysis significantly increased pulmonary complications, reintubations, ventilation time, and ICU stay.
Conclusions:
- Vocal cord paralysis is a frequent, often transient, complication with substantial morbidity.
- For extended transthoracic resections, a left-sided cervical anastomosis may reduce bilateral vocal cord paralysis risk.