Multidisciplinary Management of Recurrent Laryngeal Nerve Injury After Transhiatal Esophagectomy

Recurrent laryngeal nerve (RLN) injury is a significant morbidity following transhiatal esophagectomy (THE). While surgical platforms have evolved, the clinical burden and longitudinal management of these injuries remain under-characterized. This study evaluates RLN injury incidence and the effectiveness of a multidisciplinary management pathway in a contemporary cohort. A retrospective review of 135 patients undergoing THE with cervical anastomosis between 2017 and 2024 was conducted. The primary outcome was confirmed RLN injury via laryngoscopy and postoperative hoarseness. Predictors of injury and specialty follow-through with Otolaryngology (ENT) and Speech-Language Pathology (SLP) were analyzed. Postoperative hoarseness occurred in 43.7% (n = 59) of patients, while RLN injury was confirmed in 11.9% (n = 16), which falls within the reported national average. Surgical approach was not an independent predictor of injury (MIS vs. Open, P = 0.309). Notably, only 44.1% of symptomatic patients completed an ENT referral. However, 100% of those with confirmed paralysis required surgical intervention (eg, injection laryngoplasty and thyroplasty) to restore laryngeal function. Mean specialty follow-up for the intervention group was 20.8 months. RLN injury is a persistent complication of THE that is likely underdiagnosed by reactive, symptom-triggered screening. The 100% requirement for surgical correction among confirmed cases underscores that these injuries are rarely self-limiting. To bridge the significant gap in specialty follow-through and mitigate complications like aspiration, a standardized, proactive multidisciplinary referral protocol is necessary.