Four cases of phrenic nerve paralysis following surgery of thoracic esophageal carcinoma]

Four cases of phrenic nerve paralysis (two cases in right side, two cases in bilateral side) were experienced after surgery of thoracic esophageal carcinoma with extended lymph node dissection in neck and upper mediastinum. In all of the four patients, phrenic nerve paralysis was indicated by difficulties in weaning the patients from respirator, and respiratory management was requiring so many effort that the periods under respirator were prolonged from 12 to 41 days, but all patients recovered from phrenic nerve paralysis with conservative therapy and discharged. Vital capacity of the four patients at more than one year after surgery reached more than 75% in three patients and about 65% in one patient in comparison with the preoperative vital capacity, respectively. Therefore, long term result of respiratory function of these patients was not worse than that of patients without phrenic nerve paralysis. Since phrenic nerve is located nearly at the range of lymph node dissection in neck and upper mediastinum, dissection in that range is considered to have relation to injury of the phrenic nerve, but the nerve was not thought to be transected in view of the clinical course of the four patients. Although phrenic nerve paralysis has not been reported as the complication of surgery of esophageal carcinoma, in our department from 1987 it was found in 1.9% of patients who underwent surgery of thoracic esophageal carcinoma and in 16% of patients who underwent extended lymph node dissection. These results suggest the importance of care for the phrenic nerve during surgery of esophageal carcinoma with extended lymph node dissection.