Sukai Xu, Yiming Ni, Shanzhou Duan, Yongbing Chen
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.
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.