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Review
. 2025 May 30:27:68-80.
doi: 10.1016/j.sopen.2025.05.009. eCollection 2025 Sep.

Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis

Prakasini Satapathy  1   2 , Abhay M Gaidhane  3 , Nasir Vadia  4 , Soumya V Menon  5 , Kattela Chennakesavulu  6 , Rajashree Panigrahi  7 , Ganesh Bushi  8   9 , Mahendra Singh  10   11 , Sanjit Sah  12   13   14 , Awakash Turkar  15   16 , S Govinda Rao  17 , Khang Wen Goh  2   18 , Muhammed Shabil  19   20
Affiliations
Review

Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis

Prakasini Satapathy et al. Surg Open Sci. .

Abstract

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 (I2 = 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.

Keywords: Esophageal cancer; Esophagectomy; Minimally invasive surgery; Recurrent laryngeal nerve injury; Robotic surgery.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow chart showing the studies selection process.
Fig. 2
Fig. 2
Forest plot illustrating the pooled prevalence of RLN Injury.
Fig. 3
Fig. 3
Forest plot illustrating the Subgroup analysis of pooled prevalence RLN injury based on surgery type.
Fig. 4
Fig. 4
Forest plot illustrating the subgroup analysis of pooled prevalence RLN injury based on surgery approach.
Fig. 5
Fig. 5
Forest plot illustrating the subgroup analysis of pooled prevalence RLN injury based on surgeon learning curves.
Fig. 6
Fig. 6
Forest plot illustrating the subgroup analysis types RLN injury based on Esophagectomy.
See this image and copyright information in PMC

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