The Impact of the Recurrent Laryngeal Nerve Injury on Prognosis After McKeown Esophagectomy for ESCC

Figures & data

Table 1 Clinicopathological Characteristics of Patients

Variables	All Patients	RLNI (+)	RLNI (-)	P value
Total	297	95	202
Age, years				0.433
<60	134 (45.1)	46 (48.4)	88 (43.6)
≥60	163 (54.9)	49 (51.6)	114 (56.4)
Gender				0.628
Male	207 (69.7)	68 (71.6)	139 (68.8)
Female	90 (30.3)	27 (28.4)	63 (31.2)
Smoking history				0.315
Yes	204 (68.9)	69 (72.6)	135 (66.8)
No	93 (31.1)	26 (27.4)	67 (33.1)
pT stage				0.514
T1	30 (10.1)	11 (11.6)	19 (9.4)
T2	125 (42.1)	43 (45.3)	82 (40.6)
T3	115 (38.7)	31 (32.6)	84 (41.6)
T4	27 (9.1)	10 (10.5)	17 (8.4)
pN stage				0.179
N0	92 (30.9)	26 (27.4)	66 (32.7)
N1	110 (37.0)	38 (40.0)	72 (35.6)
N2	65 (22.0)	17 (17.9)	48 (23.8)
N3	30 (10.1)	14 (14.7)	16 (7.9)
pTNM stage				0.753
IA	78 (26.3)	24 (25.2)	54 (26.7)
IB	18 (6.1)	4 (2.2)	14 (6.9)
IIA	30 (10.1)	10 (10.5)	19 (9.4)
IIB	32 (10.8)	12 (12.6)	20 (9.9)
шA	73 (24.6)	24 (25.2)	49 (24.3)
шB	27 (9.1)	11 (11.6)	16 (7.9)
шC	25 (8.4)	8 (8.4)	17 (8.4)
IV	14 (4.7)	2 (2.1)	12 (5.9)
Tumor location				0.662
Upper	31 (10.4)	10 (10.5)	21 (10.5)
Middle	148 (49.9)	49 (51.6)	99 (49.0)
Lower	118 (39.7)	36 (37.9)	92 (45.5)
Adjuvant therapy				0.078
Yes	98 (32.9)	38 (40.0)	60 (29.7)
No	199 (67.1)	57 (60.0)	142 (70.3)

Abbreviation: RLNI, recurrent laryngeal nerve injury.

Table 2 Comparison of Perioperative Between Patients with RLNI and without

Variables	RLNI (+)	RLNI (-)	P value
Operation time (min)	185.9±25.9	154±15.4	0.042
Blood loss (mL)	130.3±72.7	128.3±67.9	0.151
No. total of dissected thoracic LN	16.15±6.7	15.12±6.8	0.982
No. of dissected RLN LN	6.50±4.4	4.62±3.5	0.034
No. of dissected right RLN LN	2.66±2.4	3.62±2.4	0.073
No. of dissected left RLN LN	2.87±3.1	2.01±2.4	0.094
Average time to start liquid diet (day)	10.23±5.2	5.23±3.1	0.021
Number of bronchoscopy suctions	3.67±1.7	2.11±1.5	0.032
Hospital mortality	2 (2.2)	3 (1.5)	0.241
Postoperation hospital stay (day)	11.5±5.4	7.2±4.8	0.047
Complications
Postoperative pneumonia	34 (35.8)	36 (17.8)	<0.001
Anastomotic leakage	15 (15.8)	17 (8.4)	0.012
Need of tracheostomy	5 (5.3)	4 (1.9)	<0.001
Aspiration	18 (18.9)	20 (9.9)	0.015
Hoarse voice	35 (36.8)	28 (13.7)	<0.001

Abbreviations: RLNI, recurrent laryngeal nerve injury; RLN LN, recurrent laryngeal nerve injury lymph node.

Table 3 Details of RLN Injury

RLN Injury	Number (%)
Non-injury	202 (68.1)
RLN injury	95 (31.9)
Right	21 (22.1)
Left	59 (62.1)
Bilateral	15 (15.8)
Type of RLN injury
Reduced activity on one side	38 (40.0)
Reduced activity on two sides	27 (28.4)
Paralysis of one side	24 (25.3)
Paralysis of two sides	6 (6.3)
Temporary or permanent injury
Temporary	75 (78.9)
Permanent	8 (8.4)
Undetermined	12 (12.7)

Abbreviation: RLN, recurrent laryngeal nerve.

Figure 1 The vocal cords after recurrent laryngeal nerve injury.

Figure 2 The relationships between RLNI and OS of patients with esophageal cancer were analyzed by Log rank test. The results showed that were no significant difference between patients with RLNI and without (P>0.05).

Table 4 Univariate Analysis of Prognostic Factors Influencing the Survival of Patients

Prognostic Factors	HR	95% CI	P value
Age	1.287	0.710–2.231	0.123
Sex	1.053	0.845–1.320	0.542
T stage	0.475	0.325–0.710	<0.001
N stage	0.384	0.298–0.645	<0.001
Tumor location	1.312	1.104–1.623	0.431
RLN LN metastasis	3.453	2.432–4.656	<0.001
RLN injury	1.412	0.892–1.543	0.056

Abbreviations: RLN, recurrent laryngeal nerve; HR, hazard ratio; CI, confidence interval; LN, lymph node.

Table 5 Multivariate Analysis of Prognostic Factors Influencing the Survival of Patients

Prognostic Factors	HR	95% CI	P value
T stage: T1+T2/T3+T4	1.489	1.232–1.908	<0.001
N stage:N0+N1/N2+N3	1.235	0.987–1.876	<0.001
Location of tumor: upper/others	1.321	0.965–1.589	0.123
RLN LN metastasis (yes/no)	3.321	2.412–4.578	<0.001

Abbreviations: RLN, recurrent laryngeal nerve; HR, hazard ratio; CI, Confidence interval; LN, lymph node.