Cause of recurrent laryngeal nerve paralysis following esophageal cancer surgery and preventive surgical technique along the left recurrent laryngeal nerve

Aim: Recurrent laryngeal nerve paralysis (RLNP) after esophageal cancer surgery, especially on the left, is a major clinical challenge. We believe that the use of intra-operative neural monitoring can help us to learn and identify surgical maneuvers that can cause RLNP, so as to improve the postoperative course for patients. Thus, the aim of this study was to determine the causes of RLNP and to devise a preventive surgical technique.Methods: Radical esophageal cancer surgery was performed with intra-operative neural monitoring at our institution from July 2015 to January 2019. The cause(s) of RLNP was investigated by video analysis, which enabled a preventive technique to be developed and introduced. Short-term surgical outcomes of the modified and conventional surgical methods were compared.Results: RLNP occurred in 10/57 (17.5%) of cases. The causes of paralysis were traction (n = 5), compression (n = 3), thermal injury (n = 1), and compression in cervical procedure (n = 1). Subsequently, 20 surgeries were performed between February and December 2019 using the modified technique and there was only one case (5%) of RLNP.Conclusion: The main causes of RLNP are compression and traction. Our modified technique for esophageal cancer surgery substantially decreases the incidence of RLNP post-operatively