Evidence map›Paper›PMID 41639414›Full record

ArticleSurgical endoscopy2026

Impact of intraoperative nerve integrity monitoring on recurrent laryngeal nerve paralysis in minimally invasive esophagectomy for esophageal cancer: a propensity score-matched analysis.

Junya Kitadani, Keiji Hayata, Taro Goda, Shinta Tominaga, Naoki Fukuda, Tomoki Nakai, Shotaro Nagano, Keisuke Hanada, Manabu Kawai

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Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Junya KitadaniSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan. kitadani@wakayama-med.ac.jp.ORCID http://orcid.org/0000-0002-2150-0253
Keiji HayataSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Taro GodaSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Shinta TominagaSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Naoki FukudaSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Tomoki NakaiSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Shotaro NaganoSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Keisuke HanadaClinical Research Center, Wakayama Medical University, Wakayama, Japan.
Manabu KawaiSecond Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative recurrent laryngeal nerve paralysis (RLNP) is a major complication following radical esophagectomy with superior mediastinal lymph node dissection for esophageal cancer. We evaluated whether intraoperative nerve integrity monitoring (NIM) reduces the incidence of RLNP. To our knowledge, this is one of the largest studies reported to date.

methodsWe retrospectively reviewed patients with esophageal cancer who underwent minimally invasive or robot-assisted esophagectomy at our institution between January 2013 and December 2024. NIM was introduced in January 2018 and applied to all patients thereafter. Propensity score matching was performed using logistic regression model to balance baseline characteristics.

resultsAfter propensity score matching, 125 patients were included in each group. The NIM group had significantly shorter operation times (442 vs. 470 min, P = 0.027) and less blood loss (55 vs. 90 mL, P = 0.003) than the earlier group without NIM. RLNP (Clavien-Dindo grade ≥ I) occurred significantly less frequently in the NIM group than in the non-NIM group (12.8% vs. 24.0%, P = 0.033). Multivariate analysis identified R1 resection (odds ratio: 8.957; 95% CI 2.502-32.065) and lack of NIM (odds ratio: 1.903; 95% CI 1.098-3.296) as independent risk factors for RLNP. However, NIM did not mitigate the severity of RLNP once it developed.

conclusionIntraoperative NIM significantly reduced the incidence of postoperative RLNP but it did not affect the severity. Meticulous surgical technique (especially avoiding excessive nerve traction) and vigilant intraoperative nerve identification remain essential in the prevention of RLNP.

Indexed as

Esophageal NeoplasmsEsophagectomyMonitoring, IntraoperativePostoperative ComplicationsRecurrent Laryngeal Nerve InjuriesVocal Cord ParalysisAgedFemaleHumansMaleMiddle AgedOperative TimePropensity ScoreRecurrent Laryngeal NerveRetrospective StudiesEsophageal cancerEsophagectomyNerve integrity monitoring systemRecurrent laryngeal nerve paralysis

Identifiers

PMID41639414

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.