Why Does Voice Hoarseness Occur After Esophageal Cancer Surgery?

Hoarseness after esophageal cancer surgery is primarily caused by damage to the recurrent laryngeal nerve. During the surgical procedure, the recurrent laryngeal nerves—which control the vocal cords—can be affected due to their close anatomical relationship with the esophagus and surrounding blood vessels. Additionally, trauma to the laryngeal mucosa during intubation for general anesthesia may also contribute to postoperative voice changes.

The right recurrent laryngeal nerve loops under the subclavian artery, while the left nerve passes around the aortic arch. During surgery, when the esophagus is mobilized for removal, both nerves are at risk of injury. Surgeons must carefully dissect and preserve these nerves to prevent complications. However, in some cases, especially when lymph node clearance is required near the nerves, temporary or even permanent damage can occur.

Short-term hoarseness is common if the nerve is irritated or compressed during surgery but not completely severed. Patients with unilateral (one-sided) nerve damage usually experience voice hoarseness, while bilateral damage can lead to more serious complications such as breathing difficulties due to vocal cord paralysis.

If hoarseness persists beyond six months, it may indicate complete transection or severe damage to the recurrent laryngeal nerve. In such cases, recovery is less likely and may require further interventions such as voice therapy or surgical procedures to improve vocal function. Close monitoring and early assessment by a speech-language pathologist or ENT specialist are recommended for optimal outcomes.