The prognostic effect of recurrent laryngeal nerve palsy after esophagectomy in locally advanced esophageal squamous cell carcinoma: A multi-center retrospective study.

BACKGROUND

Postoperative pneumonia following esophagectomy has been shown to adversely affect prognosis, whereas the prognostic significance of recurrent laryngeal nerve palsy (RLNP) remains unclear. This multicenter Japanese study aimed to evaluate the impact of RLNP on prognosis in patients undergoing esophagectomy for locally advanced esophageal squamous cell carcinoma (ESCC).

METHODS

A total of 343 patients with clinical Stage I-IVA ESCC who underwent esophagectomy between 2010 and 2019 at five Japanese specialized esophageal cancer centers was retrospectively collected. The occurrence of RLNP was assessed for its association with short- and long-term outcomes.

RESULTS

RLNP was observed in 65 patients (19.0 %). The 3-year overall survival (OS) rates were 69.8 % in the RLNP+ group and 70.5 % in the RLNP- group, with no significant difference (hazard ratio [HR]: 1.02, 95 % confidence interval [CI]: 0.65-1.59, p = 0.95). RLNP was significantly associated with clinical N-positive status (p = 0.04) and intrathoracic anastomosis (p = 0.03) but was not correlated with other clinicopathological or perioperative factors. Although RLNP+ patients had longer postoperative hospital stays, there were no significant differences in operative time, blood loss, number of harvested lymph nodes, or rates of postoperative complications, including pneumonia and anastomotic leakage. Multivariable analysis identified postoperative pneumonia as a poor prognostic factor for OS (HR: 1.60, 95 % CI: 1.06-2.41, p = 0.03), whereas RLNP was not (HR: 0.91, 95 % CI: 0.58-1.43, p = 0.69).

CONCLUSIONS

This study demonstrated that RLNP following esophagectomy for locally advanced ESCC does not significantly affect long-term survival.