Postoperative recurrent laryngeal nerve paralysis (RLNP) is a major complication following radical esophagectomy with superior mediastinal lymph node dissection for esophageal cancer. We evaluated whether intraoperative nerve integrity monitoring (NIM) reduces the incidence of RLNP. To our knowledge, this is one of the largest studies reported to date. We retrospectively reviewed patients with esophageal cancer who underwent minimally invasive or robot-assisted esophagectomy at our institution between January 2013 and December 2024. NIM was introduced in January 2018 and applied to all patients thereafter. Propensity score matching was performed using logistic regression model to balance baseline characteristics. After propensity score matching, 125 patients were included in each group. The NIM group had significantly shorter operation times (442 vs. 470 min, P = 0.027) and less blood loss (55 vs. 90 mL, P = 0.003) than the earlier group without NIM. RLNP (Clavien–Dindo grade ≥ I) occurred significantly less frequently in the NIM group than in the non-NIM group (12.8% vs. 24.0%, P = 0.033). Multivariate analysis identified R1 resection (odds ratio: 8.957; 95% CI 2.502–32.065) and lack of NIM (odds ratio: 1.903; 95% CI 1.098–3.296) as independent risk factors for RLNP. However, NIM did not mitigate the severity of RLNP once it developed. Intraoperative NIM significantly reduced the incidence of postoperative RLNP but it did not affect the severity. Meticulous surgical technique (especially avoiding excessive nerve traction) and vigilant intraoperative nerve identification remain essential in the prevention of RLNP.
Kitadani et al. (Wed,) studied this question.
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