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Prognostic Factors for Recovery from Left Recurrent Laryngeal Nerve Palsy After Minimally Invasive McKeown Esophagectomy: A Retrospective Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Recurrent laryngeal nerve (RLN) palsy is a serious complication of esophagectomy that affects the patient’s phonation and the ability to prevent life-threatening aspiration events. The aim of this single-center, retrospective study was to investigate the clinical course of left RLN palsy and to identify the main prognostic factors for recovery.

Methods

The study cohort consisted of 85 patients who had developed left RLN palsy after minimally invasive McKeown esophagectomy. Vocal cord function was assessed in all participants through laryngoscopic examinations, both in the immediate postoperative period and during follow-up. Permanent palsy was defined as no evidence of recovery after 6 months. Univariate and multivariable logistic regression analyses were applied to evaluate the associations between different variables and the outcome of palsy.

Results

Twenty-two (25.8%) patients successfully recovered from left RLN palsy. On multivariable logistic regression analysis, active smoking (odds ratio [OR] 0.335, p = 0.038) and the use of thoracoscopic surgery (vs. robotic surgery; OR 0.264, p = 0.028) were identified as independent unfavorable predictors for recovery from palsy. The estimated rates of recovery derived from a logistic regression model for patients harboring two, one, or no risk factors were 13.16%, 31.15−34.75%, and 61.39%, respectively.

Conclusion

Only one-quarter of patients who had developed left RLN palsy after minimally invasive McKeown esophagectomy were able to fully recover. Smoking habits and the surgical approach were identified as key determinants of recovery. Patients harboring adverse prognostic factors are potential candidates for early intervention strategies.

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Funding

This study was financially supported by grants CORPG3L0321 and 3J0621 from the CGMH-LK, Taiwan.

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Author notes

  1. Chun-Ting Kuo and Chien-Hung Chiu contributed equally to this work.

Authors and Affiliations

  1. Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan

    Chun-Ting Kuo MD, Chien-Hung Chiu MD & Yin-Kai Chao MD, PhD

  2. Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan

    Tuan-Jen Fang MD

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  1. Chun-Ting Kuo MD
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Corresponding author

Correspondence to Yin-Kai Chao MD, PhD.

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Chun-Ting Kuo, Chien-Hung Chiu, Tuan-Jen Fang, and Yin-Kai Chao declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Kuo, CT., Chiu, CH., Fang, TJ. et al. Prognostic Factors for Recovery from Left Recurrent Laryngeal Nerve Palsy After Minimally Invasive McKeown Esophagectomy: A Retrospective Study. Ann Surg Oncol 31, 1546–1552 (2024). https://doi.org/10.1245/s10434-023-14560-7

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  • DOI: https://doi.org/10.1245/s10434-023-14560-7

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