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Objective: Recurrent laryngeal nerve (RLN) paralysis was previously believed to be a major cause of dysphagia after esophageal cancer surgery. However, reports from recent years have indicated that dysphagia may be caused by decreased laryngeal elevation due to cervical lymph-node dissection (LND). For this reason, we studied whether a relation exists between postoperative decrease in geniohyoid muscle mass and postoperative dysphagia in patients treated for thoracic esophageal cancer. Methods and Results: Our study was retrospective and included 54 patients who underwent surgery for esophageal cancer at our hospital between April 2014 and August 2018. Computed tomography (CT) had been performed on postoperative days (POD) 5-8 and laryngeal video fluoroscopy on POD 7. The patients were divided between those with and without dysphagia and those with and without preoperative sarcopenia, and clinical variables were compared between the patient groups. The dysphagia group (n=12) had significantly lower postoperative prealbumin (PA) values (18±7 vs. 22±6; P<0.05) than the non-dysphagia group (n=42). Three-region cervical LND was performed in a greater percentage of patients in the dysphagia group than in the non-dysphagia group (9/3 (75.0%) vs 15/27 (35.7%); P<0.05). In addition, decreases in the psoas major and geniohyoid muscle cross-sectional areas were significantly less in the dysphagia group 93.0±5.1% vs. 98.4±8.3%; P<0.05 and 77.5±11.3% vs. 88.2±16.5%; P<0.05, respectively). The cross-sectional area of the geniohyoid muscle was significantly smaller in patients with preoperative sarcopenia than in those without sarcopenia 82.8±11.1% vs. 90.6±21.1%; P<0.05). Conclusion: Our findings suggest that a postoperative decrease in geniohyoid muscle mass causes the dysphagia seen in patients after esophageal cancer surgery. In addition, dysphagia may occur more readily in patients with pre-existing sarcopenia.

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