Postoperative esophageal achalasia after robotic left lower lobectomy for lung cancer: a case report.

backgroundPostoperative esophageal achalasia after lung surgery is extremely rare. Vagal nerve injury has been proposed as a possible mechanism of postsurgical esophageal dysmotility. We report a rare case of esophageal achalasia following robot-assisted lung cancer surgery. CASE PRESENTATION: A 63-year-old woman with lung adenocarcinoma (cT1cN0M0, stage IA3) underwent robot-assisted left lower lobectomy with systematic mediastinal lymph node dissection. On postoperative day 2, she developed vomiting and difficulty eating. Computed tomography revealed esophageal dilatation with retained food, and esophagography demonstrated absent esophageal peristalsis, narrowing at the esophagogastric junction, and contrast retention. Upper gastrointestinal endoscopy revealed no mechanical obstruction. High-resolution manometry confirmed esophageal achalasia. Pneumatic dilation was performed on postoperative day 15, resulting in improvement of esophagogastric junction relaxation. She was discharged on postoperative day 24 and remained well without recurrence of achalasia 6 years after surgery.

conclusionPostoperative achalasia is a rare complication of lung surgery. Although the causal mechanism in this case could not be established, perioperative vagal nerve or esophageal plexus injury was considered a possible mechanism. Careful handling of the vagus nerve and cautious use of energy devices near the esophagus may help prevent this complication, and achalasia should be considered in patients with persistent dysphagia after lung surgery.