ArticleJournal of thoracic disease2026
Prognostic significance of recurrent laryngeal nerve lymph node dissection in esophageal squamous cell carcinoma: a systematic review and meta-analysis.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
Background: Whether recurrent laryngeal nerve lymph node dissection (RLN-LND) improves survival in esophageal squamous cell carcinoma (ESCC) remains controversial. This systematic review and meta-analysis aimed to evaluate the prognostic significance of RLN-LND in ESCC patients undergoing radical esophagectomy. Methods: We systematically searched Web of Science, PubMed, Cochrane Library, and Embase from inception to June 2026 for studies comparing overall survival (OS) and disease-free survival (DFS) between RLN-LND and non-RLN-LND groups in ESCC patients. Eligibility criteria were based on PICOS framework: population-ESCC patients undergoing radical esophagectomy; intervention-RLN-LND; comparison-non-RLN-LND; outcomes-OS and DFS; study design-randomized controlled trials (RCTs) and observational studies. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.4 and Stata 15.0. Publication bias was evaluated by funnel plots, Begg's test, Egger's test, and trim-and-fill method. Heterogeneity was assessed by Q-test and I2. Results: Seven retrospective studies involving 4,570 patients (3,133 in RLN-LND group and 1,437 in non-RLN-LND group) were included. All studies were rated as high quality (NOS scores ≥7). Meta-analysis showed improved OS [hazard ratio (HR) =0.69, 95% confidence interval (CI): 0.57-0.84, P<0.001] and DFS (HR =0.65, 95% CI: 0.44-0.97, P=0.04) in the RLN-LND group versus the non-RLN-LND group. However, subgroup analysis showed no significant OS benefit in patients receiving neoadjuvant therapy plus surgery (HR =0.71, 95% CI: 0.37-1.36, P=0.30). Conclusions: Based on high-quality retrospective evidence, RLN-LND may be associated with improved OS and DFS in ESCC patients undergoing upfront surgery, but not in those receiving neoadjuvant therapy. These findings should be interpreted with caution due to the non-randomized nature of included studies, potential unadjusted confounding, and inherent limitations of retrospective designs. Prospective multicenter studies are warranted to confirm these results.
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