Impact of Phrenic Nerve Repair Using Intercostal Nerve Graft on Diaphragm Function after Thoracic Tumour Resection

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OBJECTIVES: This retrospective study investigated whether phrenic nerve repair with intercostal nerve graft affects postoperative diaphragmatic motion and respiratory function after thoracic tumour resection. METHODS: We included 11 consecutive patients (reconstruction group: n = 8; nonreconstruction group: n = 3) who underwent thoracic tumour resection with phrenic nerve removal between October 2023 and March 2025. In the reconstruction group, the intercostal and phrenic nerves were connected end-to-end using 5-0 or 6-0 Prolene sutures. Postoperative respiratory function, inspiratory/expiratory diaphragm movement distance (IEDD), and inspiratory/expiratory lung area (IEA) ratio on chest X-ray were measured using SYNAPSE VINCENT and compared between the 2 groups. RESULTS: No significant differences in age, sex, and side of phrenic nerve resected were observed between the 2 groups. IEDD ≥10 mm within 1 month postoperatively was seen in 4 (50%) patients in the reconstruction group. Mean IEDD on X-ray was 19.8 mm vs 4.1 mm (P = .013) at 1-3 months and 19.8 mm vs 4.4 mm (P = .031) at 4-6 months for the reconstruction and nonreconstruction groups, respectively. Mean IEA ratios were 1.16 vs 1.04 (P = .026) at 1-3 months and 1.19 vs 1.05 (P = .031) at 4-6 months, respectively. Postoperative respiratory function showed higher %VC (78% vs 56%, P = .008) and %FEV1 (72% vs 45%, P < .001) in the reconstruction group at 4-6 months. CONCLUSIONS: Phrenic nerve repair with intercostal nerve graft mitigated diaphragmatic dysfunction and maintained postoperative respiratory function after phrenic nerve resection. CLINICAL REGISTRATION NUMBER: 2024 Eki-102.

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