Lye Tiffany Jian-Ying, Chiu Chien-Hung, Chao Yin-Kai
Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
Dis Esophagus. 2025 May 3;38(3). doi: 10.1093/dote/doaf048.
Recurrent laryngeal nerve palsy (RLNP) is a significant complication following upper mediastinal lymphadenectomy during esophagectomy. In this retrospective study, we investigated the association between recurrent laryngeal nerve (RLN) diameter and the risk of RLNP following robot-assisted minimally invasive esophagectomy (RAMIE). We analyzed consecutive patients with esophageal cancer who underwent RAMIE between January 2015 and March 2024. The left RLN diameter was measured from intraoperative digital recordings using validated image processing software. Patients were categorized into thick and thin nerve groups based on the median RLN diameter. Rates of immediate and permanent RLNP (defined as persisting beyond 6 months) were compared between groups. Multivariable analysis was performed to adjust for potential confounders. Among 149 patients, the median left RLN diameter was 1.5 mm. Immediate RLNP rates did not differ significantly between thick (n = 67) and thin (n = 82) nerve groups (19.5% vs. 11.9%, P = 0.265). However, recovery of vocal cord function was significantly more frequent in patients with thick nerves compared with those with thin nerves (87.5% vs. 43.8%, respectively), resulting in a higher permanent RLNP rate in the thin nerve group (11% vs. 1.5%, P = 0.023). Multivariable analysis identified thin RLN as the sole independent risk factor for permanent RLNP (odds ratio: 9.22, 95% confidence interval: 1.09-78.1, P = 0.041). Patients with thin left RLNs exhibit a significantly increased risk of permanent RLNP following RAMIE. Intraoperative RLN diameter assessment may inform surgical decisions and improve postoperative management strategies.
喉返神经麻痹（RLNP）是食管癌切除术中上纵隔淋巴结清扫术后的一种严重并发症。在这项回顾性研究中，我们调查了喉返神经（RLN）直径与机器人辅助微创食管癌切除术（RAMIE）后发生RLNP风险之间的关联。我们分析了2015年1月至2024年3月期间连续接受RAMIE的食管癌患者。使用经过验证的图像处理软件从术中数字记录中测量左侧RLN直径。根据RLN直径中位数将患者分为神经粗组和神经细组。比较两组之间即刻和永久性RLNP（定义为持续超过6个月）的发生率。进行多变量分析以调整潜在的混杂因素。在149例患者中，左侧RLN直径中位数为1.5毫米。神经粗组（n = 67）和神经细组（n = 82）之间的即刻RLNP发生率无显著差异（19.5%对11.9%，P = 0.265）。然而，与神经细的患者相比，神经粗的患者声带功能恢复明显更频繁（分别为87.5%对43.8%），导致神经细组的永久性RLNP发生率更高（11%对1.5%，P = 0.023）。多变量分析确定细RLN是永久性RLNP的唯一独立危险因素（比值比：9.22，95%置信区间：1.09 - 78.1，P = 0.041）。左侧RLN细的患者在RAMIE后发生永久性RLNP的风险显著增加。术中RLN直径评估可为手术决策提供参考并改善术后管理策略。
