Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
Ann Surg Oncol. 2024 Mar;31(3):1546-1552. doi: 10.1245/s10434-023-14560-7. Epub 2023 Nov 21.
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.
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.
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.
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.
喉返神经（RLN）麻痹是食管癌手术后的一种严重并发症，会影响患者的发音和预防危及生命的吸入事件的能力。本单中心回顾性研究旨在探讨左侧 RLN 麻痹的临床过程，并确定恢复的主要预后因素。
研究队列包括 85 例接受微创 McKeown 食管癌切除术的患者，术后发生左侧 RLN 麻痹。所有参与者均通过喉镜检查评估声带功能，包括术后即刻和随访期间。永久性麻痹定义为 6 个月后无恢复迹象。应用单变量和多变量逻辑回归分析评估不同变量与麻痹结果之间的关系。
22 例（25.8%）患者左侧 RLN 麻痹成功恢复。多变量逻辑回归分析显示，主动吸烟（比值比 [OR] 0.335，p=0.038）和胸腔镜手术（与机器人手术相比；OR 0.264，p=0.028）是麻痹恢复的独立不利预测因素。从逻辑回归模型得出的具有两个、一个或没有危险因素的患者的恢复估计率分别为 13.16%、31.15-34.75%和 61.39%。
微创 McKeown 食管癌切除术后发生左侧 RLN 麻痹的患者中，只有四分之一能够完全恢复。吸烟习惯和手术方式是恢复的关键决定因素。具有不良预后因素的患者可能是早期干预策略的潜在候选者。
