448. PREDICTORS OF RECURRENT LARYNGEAL NERVE PALSY RECOVERY FOLLOWING ESOPHAGECTOMY

Background Recurrent laryngeal nerve (RLN) palsy is a serious complication of esophagectomy that significantly impacts patients’ quality of life. This condition can be permanent or temporary, and identifying the factors associated with recovery can guide treatment options and manage patient expectations. We aimed to investigate the predictors associated with recovery from RLN palsy after esophagectomy. Methods We selected patients who underwent esophagectomy between 2003 and 2022, had a minimum survival and follow-up of 6 months, and experienced right, left, or bilateral RLN palsy from a prospectively managed database. Recovery was defined as restoration of vocal fold mobility within 6 months, irrespective of dysphonia symptoms while permanent injury was defined as persistent vocal cord palsy after six months. Univariate and multivariable logistic regression analyses were used to identify associations between variables and the likelihood of recovery. Results The overall RLN palsy rate was 14.5%. Ninety-five esophagectomy patients with RLN palsy were included. The mean age at operation was 64.4 years. Fifty-two patients (54.7%) recovered from vocal cord palsy. Sixty-four patients (67.4%) underwent minimally-invasive or video-assisted thoracoscopic esophagectomy. On multivariable analysis, patients who underwent neoadjuvant therapy (OR = 0.250, P = 0.012), vocal fold augmentation (OR = 0.283, P = 0.009), or reconstruction via the retrosternal route (OR = 0.326, P = 0.036) or right chest (OR = 0.088, P = 0.046) with reference to the orthotopic route, were less likely to recover from RLN palsy. Conclusion Neoadjuvant therapy, vocal fold augmentation and the route of esophageal reconstruction were significant predictors of recovery from RLN palsy after esophagectomy.