{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T08:22:06Z","timestamp":1778314926625,"version":"3.51.4"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,1,29]],"date-time":"2018-01-29T00:00:00Z","timestamp":1517184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,1,29]],"date-time":"2018-01-29T00:00:00Z","timestamp":1517184000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"funder":[{"DOI":"10.13039\/100012553","name":"Chang Gung Memorial Hospital","doi-asserted-by":"publisher","award":["CMRPG3G0291"],"award-info":[{"award-number":["CMRPG3G0291"]}],"id":[{"id":"10.13039\/100012553","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)\u2010treated esophageal cancer patients remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN\u2010RLN(\u2212) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 56 patients (53\u00a0males and 3 females; mean age: 55 years) were included. The upper mediastinum\u2014including the bilateral RLN area\u2014was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN\u2010RLN(\u2212), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre\u2010nCRT RLN LN(cN\u2010RLN) status as the only independent predictor of ypN\u2010RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN\u2010RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN\u2010RLN(\u2212) patients who had positive and negative cN\u2010RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Nearly one\u2010fifth of ESCC patients who were judged to be ycN\u2010RLN(\u2212) unexpectedly had positive ypN\u2010RLN. The pre\u2010nCRT cN\u2010RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4516-y","type":"journal-article","created":{"date-parts":[[2018,1,29]],"date-time":"2018-01-29T20:27:22Z","timestamp":1517257642000},"page":"2485-2492","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Incidence and Predictors of Unsuspected Recurrent Laryngeal Nerve Lymph Node Metastases After Neoadjuvant Chemoradiotherapy in Patients with Esophageal Squamous Cell Carcinoma"],"prefix":"10.1002","volume":"42","author":[{"given":"Zhi\u2010Gang","family":"Li","sequence":"first","affiliation":[{"name":"Division of Thoracic Surgery Shanghai Chest Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao\u2010Bin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of 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