Multimodality Treatment for Recurrent Laryngeal Nerve Paralysis and Aspiration Pneumonia Following Resection of Thoracic Esophageal Carcinoma

During last ten years from 1981 to 1990, 311 patients with carcinoma of the thoracic esophagus were treated surgically in Kurume University Hospital. Postoperatively, 149 patients (48%) suffered from recurrent laryngeal nerve paralysis and 80 patients (26%) developed aspiration pneumonia. The incidence of aspiration pneumonia increased from 21% during the first five years (1981-85) to 31% during the later five years (1986-90) (P<0.05). The incidence of recurrent laryngeal nerve paralysis showed little difference between the two periods, 45% during the first five years and 51% during the later five years. Mortality during hospitalization due to aspiration pneumonia markedly decreased from 7% (11/155) for the first period to 2% (3/156) for the later period (P<0.05). This was caused by introduction of new multimodal treatments including (1) antethoracic reconstruction of the esophagus with gastrostomy which fascilitated decompression, (2) swallow-training starting with semi-solid foods prior to peroral intake of normal foods, (3) immediate silicone injection into the paralytic vocal fold, when necessary, and (4) surgical intervention including cricopharyngeal myotomy, laryngeal suspension and laryngectomy for severe aspiration pneumonia.