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

Prakasini Satapathy^{1

2}, Abhay M Gaidhane³, Nasir Vadia⁴, Soumya V Menon⁵, Kattela Chennakesavulu⁶, Rajashree Panigrahi⁷, Ganesh Bushi^{8

9}, Mahendra Singh^{10

11}, Sanjit Sah^{12

13

14}, Awakash Turkar^{15

16}, S Govinda Rao¹⁷, Khang Wen Goh^{2

18}, Muhammed Shabil^{19

20}

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
² Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia.
³ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
⁴ Marwadi University Research Center, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Marwadi University, Rajkot 360003, Gujarat, India.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India.
⁶ Department of Chemistry, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India.
⁷ Department of Microbiology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha 751003, India.
⁸ Chitkara Centre for Research and Development, Chitkara University Institute of Engineering and Technology, Chitkara University, Himachal Pradesh 174103, India.
⁹ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India.
¹⁰ Department of Biotechnology, Graphic Era (Deemed to be University), Clement Town, Dehradun 248002, India.
¹¹ Graphic Era Hill University, Clement Town, Dehradun, India.
¹² Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune 411018, Maharashtra, India.
¹³ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth (Deemed-to-be-University), Pune 411018, Maharashtra, India.
¹⁴ Department of Medicine, Korea Universtiy, Seoul, South Korea.
¹⁵ Centre Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura 140401, Punjab, India.
¹⁶ Division of Research and Innovation, Uttaranchal University, Dehradun, India.
¹⁷ Department of Data Science, Gokaraju Rangaraju Institute of Engineering and Technology, Bachupally, Hyderabad 500 090, Telangana, India.
¹⁸ Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia.
¹⁹ University Center for Research and Development, Chandigarh University, Mohali, Punjab, India.
²⁰ Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq.

PMID: 40697900
PMCID: PMC12282457
DOI: 10.1016/j.sopen.2025.05.009

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. 2025.

. 2025 May 30:27:68-80.

doi: 10.1016/j.sopen.2025.05.009. eCollection 2025 Sep.

Authors

Affiliations

¹ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
² Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia.
³ Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India.
⁴ Marwadi University Research Center, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Marwadi University, Rajkot 360003, Gujarat, India.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India.
⁶ Department of Chemistry, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India.
⁷ Department of Microbiology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, Odisha 751003, India.
⁸ Chitkara Centre for Research and Development, Chitkara University Institute of Engineering and Technology, Chitkara University, Himachal Pradesh 174103, India.
⁹ School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India.
¹⁰ Department of Biotechnology, Graphic Era (Deemed to be University), Clement Town, Dehradun 248002, India.
¹¹ Graphic Era Hill University, Clement Town, Dehradun, India.
¹² Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune 411018, Maharashtra, India.
¹³ Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth (Deemed-to-be-University), Pune 411018, Maharashtra, India.
¹⁴ Department of Medicine, Korea Universtiy, Seoul, South Korea.
¹⁵ Centre Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura 140401, Punjab, India.
¹⁶ Division of Research and Innovation, Uttaranchal University, Dehradun, India.
¹⁷ Department of Data Science, Gokaraju Rangaraju Institute of Engineering and Technology, Bachupally, Hyderabad 500 090, Telangana, India.
¹⁸ Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia.
¹⁹ University Center for Research and Development, Chandigarh University, Mohali, Punjab, India.
²⁰ Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq.

PMID: 40697900
PMCID: PMC12282457
DOI: 10.1016/j.sopen.2025.05.009

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.

PubMed Disclaimer

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**
PRISMA flow chart showing the studies selection process.

**Fig. 2**
Forest plot illustrating the pooled prevalence of RLN Injury.

**Fig. 3**
Forest plot illustrating the Subgroup analysis of pooled prevalence RLN injury based on surgery type.

**Fig. 4**
Forest plot illustrating the subgroup analysis of pooled prevalence RLN injury based on surgery approach.

**Fig. 5**
Forest plot illustrating the subgroup analysis of pooled prevalence RLN injury based on surgeon learning curves.

**Fig. 6**
Forest plot illustrating the subgroup analysis types RLN injury based on Esophagectomy.

See this image and copyright information in PMC

References

1. Liu C.Q., Ma Y.L., Qin Q., Wang P.H., Luo Y., Xu P.F., et al. Epidemiology of esophageal cancer in 2020 and projections to 2030 and 2040. Thorac Cancer. 2023;14(1):3–11. - PMC - PubMed
1. Cummings D., Wong J., Palm R., Hoffe S., Almhanna K., Vignesh S. Epidemiology, diagnosis, staging and multimodal therapy of esophageal and gastric tumors. Cancers. 2021;13(3):582. - PMC - PubMed
1. Bencini L., Moraldi L., Bartolini I., Coratti A. Esophageal surgery in minimally invasive era. World Journal of Gastrointestinal Surgery. 2016;8(1):52. - PMC - PubMed
1. Edmondson J., Hunter J., Bakis G., O'Connor A., Wood S., Qureshi A.P. Understanding post-Esophagectomy complications and their management: the early complications. J Clin Med. 2023;12(24) - PMC - PubMed
1. Yumoto E. Springer; Japan: 2015. Pathophysiology and surgical treatment of unilateral vocal fold paralysis; p. 6.

Publication types

Actions

LinkOut - more resources

Full Text Sources
- Elsevier Science
- PubMed Central

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources