Satapathy Prakasini, Gaidhane Abhay M, Vadia Nasir, Menon Soumya V, Chennakesavulu Kattela, Panigrahi Rajashree, Bushi Ganesh, Singh Mahendra, Sah Sanjit, Turkar Awakash, Rao S Govinda, Goh Khang Wen, Shabil Muhammed
Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia.
Surg Open Sci. 2025 May 30;27:68-80. doi: 10.1016/j.sopen.2025.05.009. eCollection 2025 Sep.
Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %-28.00 %), with substantial heterogeneity (I = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %-18.95 %) compared to 21.89 % (95 % CI, 12.92 %-34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %-40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %-100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index -1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.
食管癌仍然是全球癌症相关死亡的主要原因，而食管切除术是局部疾病的主要根治性治疗方法。然而，喉返神经（RLN）损伤是一种常见且影响较大的并发症，可损害声带功能、增加误吸风险并阻碍术后恢复。为了量化其发生率并探索相关因素，我们进行了一项系统评价和荟萃分析，纳入了24项研究和6015例患者。RLN损伤的总体合并发生率为18.36%（95%CI，11.50%-28.00%），存在显著异质性（I²=95.8%）。亚组分析显示，机器人辅助微创食管切除术（RAMIE）的合并发生率较低，为13.39%（95%CI，9.28%-18.95%），而微创食管切除术（MIE）为21.89%（95%CI，12.92%-34.62%）。在手术技术中，McKeown术式的RLN损伤发生率最高（26.32%；95%CI，15.59%-40.85%），而Ivor Lewis术式的发生率明显较低（5.77%；95%CI，1.00%-100.00%）。在低手术量或早期学习曲线中心的研究中，RLN损伤更为常见，而高手术量单中心RAMIE队列的发生率较低且异质性降低。敏感性分析支持了这些结果的稳健性，发表偏倚评估仅显示轻微不对称（LFK指数-1.81）。这些结果突出了RLN损伤的临床重要性，并支持机器人辅助技术、手术经验和术中神经监测在降低风险中的作用。标准化定义和程序培训对于改善结局和减轻这种并发症的负担至关重要。
