Risk Factors and Clinical Outcomes of Recurrent Laryngeal Nerve Paralysis After Esophagectomy for Thoracic Esophageal Carcinoma

Yu Sato, Shin‐ichi Kosugi, Naotaka Aizawa, Takashi Ishikawa, Yosuke Kano, Hiroshi Ichikawa, Takaaki Hanyu, Kotaro Hirashima, Takeo Bamba, Toshifumi Wakai

The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP. A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1-3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan-Meier method. A total of 178 (59.5 %) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1 %) patients, right in 15 (8.4 %), and left in 104 (58.4 %)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95 % confidence interval [CI] 1.06-8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95 % CI 1.78-19.80, P < 0.01). Cumulative recovery rate from RLNP was 61.7 % at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months. RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62 % of affected nerves recovered within 12 months, great attention should be given when performing these procedures.