Abstract
This report concerns a 76-year-old obese man with postoperative bilateral diaphragmatic paralysis after esophagectomy. The paralysis was successfully managed by respiratory rehabilitation and weight control. The patient was diagnosed with abdominal esophageal cancer accompanied by metastasis of the right supraclavicular lymph node. We performed a lower esophagectomy via a left thoracotomy, as well as resection of the metastatic lymph node together with the right phrenic nerve. After extubation, the patient desaturated and was diagnosed with bilateral diaphragmatic paralysis, which we considered was caused by an incision of the left diaphragm in association with resection of the right phrenic nerve. Conservative management improved pulmonary function and the patient was weaned from mechanical ventilation. When metastatic lymph nodes may invade one-sided of the phrenic nerve, a surgery involving resection of the opposite side of the diaphragm should be avoided to prevent bilateral diaphragmatic paralysis.
