408. RISK FACTORS FOR PERMANENT RECURRENT LARYNGEAL NERVE PALSY AFTER MCKEOWN MINIMAL INVASIVE ESOPHAGECTOMY

Abstract

Abstract Recurrent laryngeal nerve (RLN) palsy, especially left side, is a common complication after 3-stage McKeown esophageal cancer surgery and is related to increased risk of respiratory complication. Although some risk factors have been identified on the development of RLN palsy, data on its long-term recovery and factors affecting the recovery was scarce. The present study aimed to assess these unresolved issues. Patients who experienced left RLN palsy after McKeown minimally invasive esophagectomy (MIE) for esophageal carcinoma between 2008 and 2021 were selected from a prospective database. RLN palsy was defined based on postoperative fiberoptic laryngoscopy and was classified as permanent if recovery was not seen within 6 months. MIE was further classified as robot-assisted or conventional thoracoscopic approach. Among the 85 patients who developed left RLN palsy after MIE, recovery was observed in 22 patients (i.e., permanent palsy rate: 75%). Multivariate logistic regression analysis revealed active smoker (unfavorable, OR [95%CI]:2.99 [1.06 ~ 8.41], p = 0.038) and the use of thoracoscopic approach (unfavorable, OR [95%CI]:3.52 [1.14 ~ 10.8], p = 0.028) as independent risk factors for permanent palsy. The permanent palsy rate was 33.3% in patients who were non- or ex-smoker and received robotic approach as opposed to 85.7% in those who were smokers and received conventional thoracoscopic appraoch (p < 0.001). Among the patients who developed left RLN palsy after McKeown MIE, only one-fourth could be fully recovered. RLN palsy occurred in patients who were smoker and received thoracoscopic approach were less likely to have spontaneous recover and might be candidates for early intervention.