Influence of recurrent laryngeal nerve paralysis after esophagectomy on the completion rate of adjuvant therapy and long-term survival

doi:10.3877/cma.j.issn.2095-8773.2018.02.02

Abstract

Abstract:

Objective

To explore the risk factors for recurrent laryngeal nerve paralysis(RLNP) after esophagectomy, analyze the influence of RLNP on the completion rate of adjuvant therapy and long-term survival.

Methods

The clinical and pathological data of 762 consecutive cases of esophageal squamous cell carcinoma in the department of thoracic surgery, Shanghai chest hospital from January 2013 to December 2015 were analyzed retrospectively.

Results

The incidence of RLNP in this study was 13.6%. Multivariate analysis showed that McKeown procedure and lymph node metastasis along the recurrent laryngeal nerve were independent risk factors for RLNP(P<0.05). The results of survival analysis showed that 3 years-OS of RLNP group was lower than that of no RLNP group (47.9% vs 50.9%), 3 years-DFS of RLNP group was lower than that of no RLNP group (41.6% vs 42.6%), but the difference were not statistically significant (P>0.05). The 3 years-OS of RLNP-delayed adjuvant therapy group was lower than that of no RLNP group (48.4% vs 57.1%), and 3 years-DFS of RLNP-delayed adjuvant therapy group was lower than that of no RLNP group (38.7% vs 47.3%), but the difference was not statistically significant (P>0.05).

Conclusions

Lymph node metastasis along the recurrent laryngeal nerve were independent risk factors for RLNP. Adjuvant chemotherapy was delayed by RLNP which may deteriorate long-term prognosis of histological node positive patients.

Key words: Esophageal cancer, Recurrent laryngeal nerve paralysis, Adjuvant therapy

Xufeng Guo, Xiaobing Zhang, bing Li, Haiyong Gu, Yu Yang, Yifeng Sun, Bo Ye, Rong Hua, Teng Mao, Zhigang Li. Influence of recurrent laryngeal nerve paralysis after esophagectomy on the completion rate of adjuvant therapy and long-term survival[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2018, 05(02): 75-79.

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Figures/Tables 7

References 11

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参数		VCP组(N＝104)	无VCP组(N＝658)	统计值	P值
年龄(±s，岁)		63.1±8.1	61.5±7.4	t＝3.12	0.018
性别[n(%)]		?	?	χ²＝8.44	0.323
?	男性	82 (78.8)	545 (82.8)	?	?
?	女性	22 (21.2)	113 (17.2)	?	?
肿瘤位置[n(%)]		?	?	χ²＝11.28	0.223
?	胸上段	12 (11.5)	55 (8.4)	?	?
?	胸中段	67 (64.4)	395 (60.0)	?	?
?	胸下段	25 (24.0)	208 (31.6)	?	?
参数		VCP组(N＝104)	无VCP组(N＝658)	统计值	P值
手术时间(±s，min)		248.2±60.0	234.6±61.2	t＝1.53	0.076
术中失血量(±s，ml)		266.1±166.7	239.0±141.4	t＝5.36	0.180
病理T分期[n(%)]		?	?	χ²＝2.87	0.037
?	T0	1(1.0)	13(2.0)	?	?
?	T1	13(12.5)	136(20.7)	?	?
?	T2	31(29.8)	120(18.2)	?	?
?	T3	57(54.8)	367(55.8)	?	?
?	T4a	2(1.9)	22(3.3)	?	?
病理N分期[n(%)]		?	?	χ²＝16.01	0.562
?	N0	60(57.7)	392(59.6)	?	?
?	N1	25(24.0)	179(27.2)	?	?
?	N2	17(16.3)	77(11.7)	?	?
?	N3	2(1.9)	10(1.5)	?	?
淋巴结清扫总数(±s，枚)		13.3±6.4	12.7±6.4	t＝4.32	0.369
喉返神经旁淋巴结清扫数量(±s，枚)		2.4±2.3	1.8±1.9	t＝6.28	0.005

参数		VCP组(N＝104)	无VCP组(N＝658)	统计值	P值
年龄(±s，岁)		63.1±8.1	61.5±7.4	t＝3.12	0.018
性别[n(%)]		?	?	χ²＝8.44	0.323
?	男性	82 (78.8)	545 (82.8)	?	?
?	女性	22 (21.2)	113 (17.2)	?	?
肿瘤位置[n(%)]		?	?	χ²＝11.28	0.223
?	胸上段	12 (11.5)	55 (8.4)	?	?
?	胸中段	67 (64.4)	395 (60.0)	?	?
?	胸下段	25 (24.0)	208 (31.6)	?	?
参数		VCP组(N＝104)	无VCP组(N＝658)	统计值	P值
手术时间(±s，min)		248.2±60.0	234.6±61.2	t＝1.53	0.076
术中失血量(±s，ml)		266.1±166.7	239.0±141.4	t＝5.36	0.180
病理T分期[n(%)]		?	?	χ²＝2.87	0.037
?	T0	1(1.0)	13(2.0)	?	?
?	T1	13(12.5)	136(20.7)	?	?
?	T2	31(29.8)	120(18.2)	?	?
?	T3	57(54.8)	367(55.8)	?	?
?	T4a	2(1.9)	22(3.3)	?	?
病理N分期[n(%)]		?	?	χ²＝16.01	0.562
?	N0	60(57.7)	392(59.6)	?	?
?	N1	25(24.0)	179(27.2)	?	?
?	N2	17(16.3)	77(11.7)	?	?
?	N3	2(1.9)	10(1.5)	?	?
淋巴结清扫总数(±s，枚)		13.3±6.4	12.7±6.4	t＝4.32	0.369
喉返神经旁淋巴结清扫数量(±s，枚)		2.4±2.3	1.8±1.9	t＝6.28	0.005

影响因素		VCP组(N＝104)	无VCP组(N＝658)	χ²值	P值
肿瘤位置		?	?	10.04	0.223
?	胸上段	12 (11.5)	55 (8.4)	?	?
?	胸中段	67 (64.4)	395 (60.0)	?	?
?	胸下段	25 (24.0)	208 (31.6)	?	?
手术方式		?	?	7.33	0.884
?	微创	40 (38.5)	258(39.2)	?	?
?	开放	64 (61.5)	400 (60.8)	?	?
手术径路		?	?	18.61	<0.001
?	McKeown术	88 (84.6)	443 (67.3)	?	?
?	Ivor-Lewis术	16 (15.4)	215 (32.7)	?	?
双侧喉返神经旁淋巴结清扫		?	?	13.95	0.015
?	是	80 (76.9)	426 (64.7)	?	?
?	否	24 (23.1)	232 (35.3)	?	?
喉返神经旁淋巴结转移		?	?	17.82	<0.001
?	是	27 (26.0)	85 (12.9)	?	?
?	否	77 (74.0)	573 (87.1)	?	?

影响因素		VCP组(N＝104)	无VCP组(N＝658)	χ²值	P值
肿瘤位置		?	?	10.04	0.223
?	胸上段	12 (11.5)	55 (8.4)	?	?
?	胸中段	67 (64.4)	395 (60.0)	?	?
?	胸下段	25 (24.0)	208 (31.6)	?	?
手术方式		?	?	7.33	0.884
?	微创	40 (38.5)	258(39.2)	?	?
?	开放	64 (61.5)	400 (60.8)	?	?
手术径路		?	?	18.61	<0.001
?	McKeown术	88 (84.6)	443 (67.3)	?	?
?	Ivor-Lewis术	16 (15.4)	215 (32.7)	?	?
双侧喉返神经旁淋巴结清扫		?	?	13.95	0.015
?	是	80 (76.9)	426 (64.7)	?	?
?	否	24 (23.1)	232 (35.3)	?	?
喉返神经旁淋巴结转移		?	?	17.82	<0.001
?	是	27 (26.0)	85 (12.9)	?	?
?	否	77 (74.0)	573 (87.1)	?	?

参数	OR	95% CI	P值
手术径路(McKeown/Ivor-Lewis)	2.230	1.300～4.177	0.004
双侧喉返神经旁淋巴结清扫(是/否)	1.178	0.692～2.008	0.546
喉返神经旁淋巴结转移(是/否)	1.990	1.179～3.360	<0.001

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