{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:11:11Z","timestamp":1785773471746,"version":"3.56.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,12,4]],"date-time":"2021-12-04T00:00:00Z","timestamp":1638576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n\u00a0=\u200970) and a control group (control, n\u00a0=\u200980). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P\u00a0=\u20090.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P\u00a0=\u20090.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P\u00a0&amp;lt;\u20090.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74\u2009\u00b1\u20095.77 vs. 11.03\u2009\u00b1\u20095.78, P\u00a0=\u20090.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/dote\/doab080","type":"journal-article","created":{"date-parts":[[2021,12,5]],"date-time":"2021-12-05T09:10:23Z","timestamp":1638695423000},"source":"Crossref","is-referenced-by-count":8,"title":["Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy"],"prefix":"10.1093","volume":"35","author":[{"given":"Luo","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"He","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingzhi","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongsheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanqing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhijun","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Peking Union Medical College Hospital , Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,4]]},"reference":[{"issue":"2","key":"2022071308253651100_ref1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3322\/caac.21338","article-title":"Cancer statistics in China, 2015","volume":"66","author":"Chen","year":"2016","journal-title":"CA Cancer J Clin."},{"issue":"1","key":"2022071308253651100_ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1620\/tjem.237.1","article-title":"Recurrent laryngeal nerve paralysis after esophagectomy: respiratory complications and role of nerve reconstruction","volume":"237","author":"Koyanagi","year":"2015","journal-title":"Tohoku J Exp Med."},{"issue":"5","key":"2022071308253651100_ref3","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1442-2050.2012.01414.x","article-title":"Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer","volume":"27","author":"Zhong","year":"2014","journal-title":"Dis Esophagus."},{"issue":"Suppl 3","key":"2022071308253651100_ref4","doi-asserted-by":"crossref","first-page":"S18","DOI":"10.1002\/lary.27360","article-title":"International neuromonitoring study group guidelines 2018: part II: optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data","volume":"128","author":"Wu","year":"2018","journal-title":"Laryngoscope."},{"key":"2022071308253651100_ref5","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.ijsu.2018.05.738","article-title":"Technique and surgical outcomes of mesenterization and intra-operative neural monitoring to reduce recurrent laryngeal nerve paralysis after thoracoscopic esophagectomy: a cohort study","volume":"56","author":"Kobayashi","year":"2018","journal-title":"Int J Surg."},{"issue":"3","key":"2022071308253651100_ref6","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.asjsur.2016.10.005","article-title":"Esophageal cancer: risk factors, genetic association, and treatment","volume":"41","author":"Huang","year":"2018","journal-title":"Asian J Surg."},{"issue":"26","key":"2022071308253651100_ref7","first-page":"717","article-title":"Reflections on three field lymphadenectomy in carcinoma of the esophagus and gastroesophageal junction","volume":"46","author":"Lerut","year":"1999","journal-title":"Hepatogastroenterology."},{"key":"2022071308253651100_ref8","first-page":"311","article-title":"Does lymphadenectomy add anything to the treatment of esophageal cancer?","volume":"33","author":"Law","year":"1999","journal-title":"Adv Surg."},{"key":"2022071308253651100_ref9","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/978-3-642-59600-1_13","article-title":"Significance of extended systemic lymph node dissection for thoracic esophageal carcinoma in Japan","volume":"155","author":"Watanabe","year":"2000","journal-title":"Recent Results Cancer Res."},{"issue":"3","key":"2022071308253651100_ref10","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/S1072-7515(97)00046-X","article-title":"Prognostic value of thoracic recurrent nerve nodal involvement in esophageal squamous cell carcinoma","volume":"185","author":"Malassagne","year":"1997","journal-title":"J Am Coll Surg."},{"issue":"8","key":"2022071308253651100_ref11","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s00423-020-01990-0","article-title":"Recurrent laryngeal nerve monitoring during totally robot-assisted Ivor Lewis esophagectomy","volume":"405","author":"Staubitz","year":"2020","journal-title":"Langenbecks Arch Surg."},{"issue":"6","key":"2022071308253651100_ref12","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/coa.12913","article-title":"Vocal palsy increases the risk of lower respiratory tract infection in low-risk, low-morbidity patients undergoing thyroidectomy for benign disease: a big data analysis","volume":"42","author":"Nouraei","year":"2017","journal-title":"Clin Otolaryngol."},{"issue":"12","key":"2022071308253651100_ref13","doi-asserted-by":"crossref","first-page":"2965","DOI":"10.1007\/s00464-010-1072-4","article-title":"Lymphadenectomy along the left recurrent laryngeal nerve by a minimally invasive esophagectomy in the prone position for thoracic esophageal cancer","volume":"24","author":"Noshiro","year":"2010","journal-title":"Surg Endosc."},{"issue":"Suppl 1","key":"2022071308253651100_ref14","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1002\/lary.21119","article-title":"Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement","volume":"121","author":"Randolph","year":"2011","journal-title":"Laryngoscope."},{"issue":"2","key":"2022071308253651100_ref15","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1002\/lary.27327","article-title":"Prediction of postoperative vocal fold function after intraoperative recovery of loss of signal","volume":"129","author":"Schneider","year":"2019","journal-title":"Laryngoscope."}],"container-title":["Diseases of the 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