Vocal cord paralysis after subtotal oesophagectomy

Background: Although vocal cord paralysis is a well known complication of s ubtotal oesophagectomy, precise data concerning origin, incidence and assoc iated morbidity are lacking. Methods: A retrospective study was performed of 241 patients who underwent transhiatal oesophagectomy for carcinoma of the mid/distal oesophagus betwe en 1994 and 1998. Preoperative and postoperative laryngoscopy results were available for 140 patients. Results: There were 109 men and 31 women, of mean age 63 years. Thirty-one patients (22 per cent) with recurrent laryngeal nerve paralysis were identi fied, three with bilateral and 28 with unilateral dysfunction. Paralysis oc curred ipsilateral to the side of the cervical incision in 22 of 28 patient s. It was permanent in six patients. The associated morbidity was substanti al: pulmonary complications were more common in patients with vocal cord pa ralysis (12 of 31 versus 26 (24 per cent) of 109), leading to significantly more reintubations, and a significantly prolonged ventilation time and sta y in the intensive care unit. Conclusion: Although mostly transient, vocal cord paralysis is a frequent c omplication with significant associated morbidity. In an extended transthor acic resection (including a lymphadenectomy in the aortopulmonary window wh ere the left recurrent laryngeal nerve is at risk) the cervical anastomosis should be made on the left side, to minimize the risk of bilateral vocal c ord paralysis.