441. combining laryngeal ultrasonography (lusg) with voice assessment or intra-operative nerve monitoring results accurately confirms normal vocal cord function after esophagectomy

Abstract Background 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. Methods 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. Results 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. Conclusion 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.