Swallowing difficulty is among the major complications that can occur after surgery for thoracic esophageal cancer. Recurrent laryngeal nerve paralysis (RLNP) has been considered the most significant cause of a postoperative swallowing difficulty, but association between the two has not been adequately explained. We investigated the relation between postoperative RLNP and swallowing difficulty by means of video fluoroscopy. Our study included 32 patients who underwent subtotal esophagectomy for thoracic esophageal cancer at St. Marianna University School of Medicine between April 2014 and March 2017. We evaluated patients’ age and sex, disease stage, preoperative presence of a swallowing difficulty, nutritional status, extent and duration of surgery, blood loss volume, and postoperative presence of RLNP and/or hoarseness. Patients were divided into two groups according to whether oral food intake was possible when video fluoroscopy was performed on postoperative day (POD) 7, and we analyzed the associated factors. Postoperative RLNP occurred in 21 patients (65.6%); hoarseness occurred in 19 (59.4%). Eleven patients (34.4%) suffered swallowing difficulty that prevented food intake. No significant association was found between postoperative swallowing difficulty and postoperative RLNP or hoarseness, but a significant relation was found between the prognostic nutritional index and intraoperative lymph node dissection. Multivariable analysis revealed a significant relation between postoperative swallowing difficulty and only one factor: cervical lymph node dissection ( P = 0.0075). There appears to be no relation between RLNP pursuant to esophageal cancer surgery and swallowing difficulty that prevents oral food intake.

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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Colorectal neuroendocrine carcinoma NEC is extremely rare and has a dismal prognosis. However, no standardized treatment strategy has been established for this lesion. For patients with NEC and distant metastasis, disease stabilization is dif cult even after treatment with multidisciplinary strategies including chemotherapy. Here we describe a case of rectal NEC that presented as multiple liver metastases; a favorable prognosis was obtained after treatment with a multidisciplinary strategy that included surgery, irradiation, and chemotherapy. A 66-year-old male presented with diarrhea and constipation. Colonoscopy and a computed tomography CT scan revealed a rectal mass involving all of the luminal circumference, after which a diagnosis of NEC was con rmed by pathological examination. A CT scan also revealed several liver metastases in S5, S6, and S8. Abdominoperineal resection with total mesenteric excision and lymphadenectomy, including the lateral area, was performed. After resection, we administered radiation for local disease control in the lateral area. We also administered chemotherapy consisting of cisplatin and irinotecan for the liver metastases because only the endocrine cell component constituted this tumor. After chemotherapy, a CT scan was performed to con rm that the liver metastasis in S5 and S6 had disappeared, and it was shown that the other lesion in S8 had shrunk substantially it eventually disappeared. Then, 48 months after resection, all metastatic liver tumors were under good control, and no other recurrent lesion was recognized. In conclusion, a multidisciplinary strategy including optimal chemotherapy seems to be important to achieve a favorable prognosis of NEC of the colorectum with distant metastasis..