Prakasini Satapathy, Abhay M. Gaidhane, Nasir Vadia, Soumya V. Menon, Kattela Chennakesavulu, Rajashree Panigrahi, Ganesh Bushi, Mahendra Singh, Sanjit Sah, Awakash Turkar, S. Govinda Rao, Khang Wen Goh, Muhammed Shabil
Background: 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. © 2025
Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia; Jawaharlal Nehru Medical College and Global Health Academy, School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education, Wardha, India; Marwadi University Research Center, Department of Pharmaceutical Sciences, Faculty of Health Sciences, Marwadi University, Gujarat, Rajkot, 360003, India; Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Karnataka, Bangalore, India; Department of Chemistry, Sathyabama Institute of Science and Technology, Tamil Nadu, Chennai, India; Department of Microbiology, IMS and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Odisha, Bhubaneswar, 751003, India; Chitkara Centre for Research and Development, Chitkara University Institute of Engineering and Technology, Chitkara University, Himachal Pradesh, 174103, India; School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India; Department of Biotechnology, Graphic Era (Deemed to be University), Dehradun, Clement Town, 248002, India; Graphic Era Hill University, Dehradun, Clement Town, India; Department of Paediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Maharashtra, Pune, 411018, India; Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth (Deemed-to-be-University), Maharashtra, Pune, 411018, India; Department of Medicine, Korea Universtiy, Seoul, South Korea; Centre Centre for Research Impact and Outcome, Chitkara University Institute of Engineering and Technology, Chitkara University, Punjab, Rajpura, 140401, India; Division of Research and Innovation, Uttaranchal University, Dehradun, India; Department of Data Science, Gokaraju Rangaraju Institute of Engineering and Technology, Bachupally, Telangana, Hyderabad, 500 090, India; Faculty of Mathematics and Natural Sciences, Universitas Negeri Padang, Padang, Indonesia; University Center for Research and Development, Chandigarh University, Punjab, Mohali, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, Babil, Hillah, 51001, Iraq
