Is there a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer?

A best evidence topic was written according to a structured protocol. The question addressed was whether there is a role for intraoperative recurrent laryngeal nerve monitoring during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. A total of 125 papers were identified using the reported searches of which 2 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, study type, patient group, relevant outcomes and results are tabulated. Oesophageal surgery, similar to thyroid, parathyroid and cardiothoracic surgery poses a risk to the recurrent laryngeal nerves (RLN). Intraoperative RLN monitoring (IONM) is commonly being used in thyroid and parathyroid surgery in many centres. The same does not hold true for three-stage oesophagectomy with high mediastinal lymph node dissection despite the inherent risks to the RLN being much higher with this type of surgery. There are only a handful of studies in the literature evaluating the role of IONM in three-stage oesophagectomy. As a result, there is limited evidence to provide robust guidance. The evidence from the present review supports the use of IONM during high mediastinal lymph node dissection in three-stage oesophagectomy for oesophageal cancer. IONM appears to have a protective role for the RLN and also reduce the risk of postoperative pneumonia without adding to the operative time. In patients due to undergo three-stage oesophagectomy, the use of IONM of the RLN should be considered during the high mediastinal lymph node dissection and cervical access parts of the operation.