Retrospective cohort study shows PRNLN dissection improves overall survival in ESCC patients, indicating need for specific adjuvant therapies.
Background To analyze the significance of para-recurrent laryngeal nerve lymph node (PRNLN) dissection in patients with esophageal squamous cell carcinoma (ESCC) and to identify appropriate postoperative adjuvant treatments for those with PRNLN metastasis. Methods This retrospective study included 1505 ESCC patients who underwent radical esophageal resection between January 2017 and January 2021. Patients were divided into two groups based on whether PRNLN dissection was performed. Propensity score matching was used to balance covariates between the groups. Kaplan–Meier survival analysis and Cox regression were employed to evaluate overall survival (OS) and disease-free survival (DFS). Factors associated with OS and DFS were analyzed. Results The 3-year and 5-year OS rates for the entire cohort were 67.7% and 59.0%, respectively. PRNLN dissection was significantly associated with increased risk of recurrent laryngeal nerve palsy (P < 0.001). Stratified analysis showed that PRNLN dissection improved OS in Stage IIB (P = 0.045), IIIA (P = 0.039), and IIIB (P = 0.034) patients. The PRNLN metastasis rate was 25.6%, and metastatic involvement was associated with poorer OS and DFS. Multivariate analysis revealed that adjuvant chemotherapy and chemoradiotherapy were independent predictors of improved OS and DFS in patients with PRNLN metastasis. Conclusion PRNLN metastasis negatively impacts the prognosis of ESCC patients. PRNLN dissection is beneficial for OS in specific stages (IIB, IIIA, and IIIB). Postoperative adjuvant chemotherapy or chemoradiotherapy is recommended for patients with PRNLN metastasis to improve survival outcomes.
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Liu et al. (2025) studied this question.