Abstract
BackgroundHoarseness is one of the classical symptoms in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), and it results from recurrent laryngeal nerve palsy, which is caused by nodal metastasis along the recurrent laryngeal nerve or by main tumors. We reviewed the short-term and long-term results of esophagectomy for patients with locally advanced ESCC and hoarseness at diagnosis.PatientsPatients who initially presented with hoarseness from recurrent laryngeal nerve palsy between 2009 and 2018 and underwent esophagectomy for thoracic ESCC were eligible for this study. Pharyngolaryngectomy or cervical ESCC were exclusionary.ResultsA total of 15 patients were eligible, and 14 underwent resection of the recurrent laryngeal nerves. The remaining patient had nerve-sparing surgery. Nine patients (60%) had post-operative complications ≥ Clavien–Dindo class II and, pulmonary complications were most common. Two patients (13%) died in the hospital. The 5-year overall survival rate for all patients was 16%. Age (≤ 65 years), cT1/T2 tumor, and remarkably good response to neoadjuvant treatment were likely related to longer survival; however, these relationships were not statistically significant.ConclusionsEsophagectomy for ESCC patients who are diagnosed with recurrent laryngeal nerve paralysis at initial presentation could be a treatment option if the patient is relatively young, has a cT1/T2 tumor, or shows a remarkably good response to neoadjuvant treatment. However, clinicians should be aware of the possibility of postoperative pulmonary complications, which were frequently observed with the procedure.
Highlights
Esophageal cancer was the seventh most common cancer worldwide and the sixth most common cause of death from cancer in 2018, with an estimated 572,034 new cases (3.2% of the total cancer cases) and 508,585 deaths (5.3% of the total cancer deaths) according to the WHO GLOBOCAN multi-disciplinary treatments for esophageal cancer have become common in the past two decades, esophagectomy with adequate lymphadenectomy remains the mainstay of curative treatment for locally advanced esophageal cancer [2]
Hoarseness, which is caused by paralysis of either side of the vocal cords, is one of the classical symptoms in patients with locally advanced esophageal cancer
Esophagus this paralysis originates from metastatic nodes along the recurrent laryngeal nerves, or sometimes from the main tumors
Summary
Esophageal cancer was the seventh most common cancer worldwide and the sixth most common cause of death from cancer in 2018, with an estimated 572,034 new cases (3.2% of the total cancer cases) and 508,585 deaths (5.3% of the total cancer deaths) according to the WHO GLOBOCAN multi-disciplinary treatments for esophageal cancer have become common in the past two decades, esophagectomy with adequate lymphadenectomy remains the mainstay of curative treatment for locally advanced esophageal cancer [2]. Esophagus this paralysis originates from metastatic nodes along the recurrent laryngeal nerves, or sometimes from the main tumors. This symptom is considered to be a poor prognostic indicator, because it could suggest an obvious extranodal invasiveness or an extremely aggressive or invasive cancer [4, 5]. Hoarseness is one of the classical symptoms in patients with locally advanced thoracic esophageal squamous cell carcinoma (ESCC), and it results from recurrent laryngeal nerve palsy, which is caused by nodal metastasis along the recurrent laryngeal nerve or by main tumors. Conclusions Esophagectomy for ESCC patients who are diagnosed with recurrent laryngeal nerve paralysis at initial presentation could be a treatment option if the patient is relatively young, has a cT1/T2 tumor, or shows a remarkably good response to neoadjuvant treatment. Clinicians should be aware of the possibility of postoperative pulmonary complications, which were frequently observed with the procedure
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