Between 1985 and 2000, 128 esophageal cancer patients underwent esophagectomy with resulting vocal cord paralysis (VCP). They were disease free at least 1 year after surgery. They were divided into Group A (63 patients operated on between 1985 and 1993) and Group B (65 patients operated on between 1994 and 2000). In 1993, we revised our surgical techniques in removing the recurrent nerve lymphatic chains in order to reduce postoperative VCP. Thus, we could compare these two groups of patients. Only two patients (3.1%) of Group B complained of severe hoarseness 1 year after surgery, as compared to 18 patients (28.6%) in Group A. Of the 108 patients who did not complain of severe hoarseness, the mean duration of their difficulty in talking was 3.3 months for Group B and 6.0 months for Group A. The incidence of the persistent VCP 1 year after surgery significantly decreased from 57.1% in Group A to 24.6% in Group B, mainly owing to a recovery from left recurrent nerve palsy. In the group of patients with severe hoarseness 1 year after surgery, daily activity and percentage of ideal body weight at 1 year had deteriorated. Severe hoarseness, therefore, does not seem to be an inevitable consequence of esophagectomy for cancer but rather to surgical maneuver and a poor nutritional state. From the viewpoint of quality of life, the permanent nerve paralysis caused by esophageal cancer surgery is worrisome and a factor in the deterioration of daily activity until it is adequately treated.