Does hoarseness of voice from recurrent nerve paralysis after esophagectomy for carcinoma influence patient quality of life?

Background: Recurrent laryngeal nerve injury caused by esophageal cancer su rgery is worrisome but often temporary; it is unclear when and how the para lysis is resolved. Hoarseness of voice from vocal cord paralysis (VCP) can have detrimental effects on postoperative patients. The aims of this study were to clarify the progress of nerve paralysis related to difficulty in ta lking after surgery and to assess whether hoarseness influences patient qua lity of life. Study Design: Between 1985 and 1996, 141 esophageal cancer patients undergo ing a resection by the Akiyama procedure were cancer free 1 year after surg ery. Among them, 51 patients with VCP on discharge from the hospital were r etrospectively reviewed. Their VCPs, body weights, and pulmonary functions were examined yearly. They were given a questionnaire relating to the diffi culty in talking 1 year after surgery. Results: VCP on discharge spontaneously healed within I year of surgery in 21 patients (41.2%), with the mean duration of difficulty in talking 5.7 mo nths. The remaining 30 patients had persistent VCP 1 year after surgery; 4 VCPs spontaneously healed approximately 2 years after surgery. Eleven of th e 30 patients with persistent VCP, who complained of severe hoarseness at 1 year postoperatively from inability to close the glottis during exertion, showed debilitation in performance status, abilities to go up stairs, and s wallowing. In the group of patients with severe hoarseness, the percentage of ideal body weight (90.6% +/- 11.0%) preoperatively and pulmonary functio ns at 3 years postoperatively were deteriorated, resulting in 3 patients wi th repeated aspiration pneumonia. Conclusions: The inability to compensate for aspiration, presenting as seve re hoarseness, may be dependent on the preoperative nutritional state of pa tients along with degree of vocal cord atrophy and a decrease in pulmonary support. Persistent nerve paralysis deteriorates quality of life until it i s adequately treated. (J Am Cell Surg 1999;188:231-236. (C) 1999 by the Ame rican College of Surgeons).