Simultaneous lung metastatic resection and diaphragmatic plication for dyspnea after combined resection of phrenic nerve for thymoma and metastatic resection

We report a case of simultaneous lung metastatic resection and diaphragmatic plication for dyspnea after combined resection of the phrenic nerve for a thymoma and metastatic resection.A 69-year-old woman had undergone combined resection of the right phrenic nerve for an invasive thymoma 3 years ago. Two years after the operation, left lung metastasis and bilateral pleural dissemination were observed, so left lower lobe partial resection and bilateral pleural dissemination resection were performed. The patient suffered from dyspnea in a supine position after the operation, so she required the use of non-invasive positive pressure ventilation. A year later, a new right lung metastasis was observed. Right lower lobe partial resection was performed with right diaphragmatic plication simultaneously to prevent exacerbation of respiratory distress. Postoperatively, dyspnea in a supine position markedly improved, and it became possible to sleep in a supine position without using non-invasive positive pressure ventilation. For the 8 years since the operation, no recurrent lesions or exacerbations of respiratory symptoms have been observed.In the presence of phrenic nerve palsy, chest surgery should be considered for possible postoperative dyspnea. A surgical approach should be designed to minimize damage to the respiratory muscles, and if postoperative dyspnea is a concern, consideration should be given to performing diaphragmatic plication simultaneously.