Combining laryngeal ultrasonography (LUSG) with voice assessment or intra-operative nerve monitoring results accurately confirms normal vocal cord function after esophagectomy (Oral Presentation)

Abstract

<p>Background</p><p>Conventional diagnosis of vocal cord paresis (VCP) after esophagectomy relies on flexible laryngoscopy (FL), which is invasive. As most patients had normal post-operative VC function, a non-invasive alternative such as laryngeal ultrasonography (LUSG) may avoid unnecessary FL. LUSG was well-known to be accurate for post-thyroidectomy VC evaluation, but its accuracy following esophagectomy was unclear. This prospective study assessed the feasibility and accuracy of LUSG to evaluate VC function on day-1 after esophagectomy.</p><p>Methods</p><p>Consecutive patients from a tertiary teaching hospital who underwent elective esophagectomy were prospectively recruited. All patients received FL and LUSG pre-operative and on post-operative Day-1, each performed by an independent, experienced blinded assessor. Exclusion criteria include pre-operative VCP and lost to VC evaluation at any time points. The primary outcome was the accuracy of LUSG in the diagnosis of VCP on Day-1 post-esophagectomy. The accuracy of intermittent intra-operative nerve monitoring (IIONM) and voice assessment (VA) after surgery for the diagnosis of VCP were also analyzed.</p><p>Results</p><p>Twenty-six patients were eligible for analysis. The median age was 70 years (66–73). Majority were male (84.6%) and had squamous cell carcinoma. (88.5%). Twenty-five (96.2%) received three-phase esophagectomy. Twenty-four (96%) had anastomosis at the neck at the same stage. There were three (11.5%) temporary and one (3.8%) permanent unilateral VCP. Sensitivity, specificity and accuracy of LUSG were 75.0%, 100.0% and 98.1% respectively, which were superior to IIONM alone (50%, 90.3%, 87.9%) or VA alone (50%, 90.9%, 84.6%). Combining LUSG with VA or IIONM improved sensitivity and negative predictive value to 100.0% and could avoid 77% FLs.</p><p>Conclusion</p><p>LUSG is an accurate method to evaluate VC function in the early post-operative period after esophagectomy. Combining LUSG with VA or IIONM results accurately confirms normal VC function after esophagectomy, and can avoid a majority of FLs.</p>