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

## TL;DR

This study shows that repairing the phrenic nerve with an intercostal nerve graft improves diaphragm function and breathing after thoracic tumor surgery.

## Contribution

The study demonstrates that phrenic nerve reconstruction using intercostal nerve grafts improves postoperative respiratory outcomes.

## Key findings

- Patients with nerve reconstruction had significantly greater diaphragm movement compared to those without reconstruction.
- Respiratory function metrics like %VC and %FEV1 were higher in the reconstruction group at 4-6 months post-surgery.
- The improvement in diaphragm function was maintained over time in the reconstruction group.

## Abstract

This retrospective study investigated whether phrenic nerve repair with intercostal nerve graft affects postoperative diaphragmatic motion and respiratory function after thoracic tumour resection.

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.

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.

Phrenic nerve repair with intercostal nerve graft mitigated diaphragmatic dysfunction and maintained postoperative respiratory function after phrenic nerve resection.

2024 Eki-102.

The diaphragm is the primary muscle responsible for respiration and is innervated by the phrenic nerve.