[Etiology, Evaluation and Comprehensive Management of Hoarseness 
after Lung Cancer Surgery]

Hoarseness after lung cancer surgery is a common but often underestimated perioperative functional complication. Beyond impairing voice quality, it may involve swallowing dysfunction and compromised airway protection, thereby increasing the risk of aspiration, pulmonary infection, and delayed recovery. Iatrogenic recurrent laryngeal nerve injury is the major cause, closely associated with mediastinal lymph node dissection, with the left lower paratracheal lymph node station as typical high-risk anatomical areas. Nerve injury results from both direct mechanical trauma and indirect mechanisms such as traction and thermal spread. In addition, intubation-related laryngeal trauma can also present as postoperative hoarseness and should be differentiated from neurogenic causes. This review summarizes the etiology and risk factors, outlines postoperative evaluation and preventive strategies, and discusses the role of meticulous dissection, minimized thermal injury, and appropriate intraoperative neuromonitoring. Future prospective studies are needed to standardize outcomes and clarify the optimal timing and target populations for interventions, ultimately improving comprehensive perioperative management and patients' quality of life.
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