An Investigation of Factors Related to Food Intake Ability and Swallowing Difficulty After Surgery for Thoracic Esophageal Cancer

Abstract

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.

Effect of Postoperative Oral Intake Status on Sarcopenia Six Months After Esophageal Cancer Surgery

“…Dysphagia, oral intake status, and nutritional status during the perioperative period and six months after surgery This study showed that 34.3% of patients were judged to be unable to start oral intake at one week after esophagectomy, which is consistent with a previous study [33]. These patients were signi cantly more likely to receive tube feeding at discharge, suggesting a good indication for prioritized nutrition education.…”

Effect of Postoperative Oral Intake Status on Sarcopenia Six Months after Esophageal Cancer Surgery

“…Higher cut-offs of SMI are shown to signi cantly increase the prevalence of sarcopenia [30], which might have affected the results of the present study. Dysphagia, intake status, and nutritional status during the perioperative period and six months after surgery This study showed that 34.3% of patients were judged to be unable to start oral intake at one week after esophagectomy, which is consistent with a previous study [33]. These patients were signi cantly more likely to receive tube feeding at discharge, suggesting a good indication for prioritized nutrition education.…”

Relation between Decrease in Geniohyoid Muscle Mass and Dysphagia after Surgery for Thoracic Esophageal Cancer

“…RLN paralysis has been believed to be a major cause of dysphagia after esophageal cancer surgery and closely related to the condition 1) . However, in recent years, reports have indicated that RLN paralysis is not directly related to dysphagia and have instead stated that decreased postoperative laryngeal elevation and the inclusion of cervical LND are major risk factors for development of dysphagia [2][3][4] . Yasuda et al 3) indicated that cervical LND may lead to restricted laryngeal elevation due to scarring of the muscle tissue.…”

“…Decreased laryngeal elevation may occur as a consequence of restricted elevation of the larynx caused by scarring of the anterior neck mus-cles from cervical lymph node dissection (LND) performed during esophageal cancer surgery 3) . In 2014, Mafune, et al showed that the effects of cervical LND, rather than RLN paralysis, cause dysphagia after this type of surgery 4) .…”