Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

Takatsu, Jun; Higaki, Eiji; Hosoi, Takahiro; Yoshida, Masahiro; Yamamoto, Masahiko; T, Abe; Shimizu, Yasuhiro

doi:10.1093/dote/doaa094

Cited by 13 publications

(20 citation statements)

References 36 publications

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“…The start of oral intake was considered after confirmation that there were no major complications on the CT scan, and a step up in diet levels and initiation of drinking water were allowed based on comprehensive judgment on each patient's progress. 22 Patients were considered for discharge if a full caloric oral diet was tolerated, and physical strength allowed personal autonomy.…”

Section: Surgical Procedures and Perioperative Managementmentioning

confidence: 99%

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Higaki

Fujieda

et al. 2021

Ann Surg Oncol

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Background. Postoperative pneumonia is a common complication after esophagectomy and is associated with a high mortality rate. Although many randomized, controlled trials have been conducted on the prevention of postoperative pneumonia, little attention has been paid to the efficacy of antimicrobial prophylaxis. The purpose of this study was to investigate the impact of antimicrobial prophylaxis on the prevention of postoperative pneumonia. Methods. Data of patients with esophageal cancer who underwent thoracoscopic esophagectomy between 2016 and 2020 were collected. Early-period patients received cefazolin (CEZ) per protocol as antimicrobial prophylaxis (n = 250), and later-period patients received ampicillin/sulbactam (ABPC/SBT) (n = 106) because of the unavailability of CEZ in Japan. The incidence of pneumonia was compared between treatments in this quasiexperimental setting. Pneumonia detected by routine computed tomography (CT) on postoperative Days 5-6 was defined as early-onset pneumonia, and pneumonia that developed later was defined as late-onset pneumonia.Results. The incidence of early-onset pneumonia was significantly lower (3.8% vs. 13.6%, P = 0.006), and the median length of postoperative hospital stay was significantly shorter (17 vs. 20 days, P \ 0.001) in the ABPC/ SBT group than in the CEZ group. The incidence of lateonset pneumonia was similar between groups (9.4% vs. 10.0%, P = 0.870). The incidence of Clostridioides difficile infections and the incidence of multidrug-resistant organisms were similar between groups. Multivariate analyses consistently showed the superiority of ABPC/SBT to CEZ in preventing early-onset pneumonia (odds ratio: 0.20, P = 0.006). Conclusions. ABPC/SBT after esophagectomy was better at preventing early-onset pneumonia compared with CEZ and was feasible regarding the development of antimicrobial resistance.

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Section: Surgical Procedures and Perioperative Managementmentioning

confidence: 99%

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Higaki

Fujieda

et al. 2021

Ann Surg Oncol

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“…Three studies with a combined total of 311 participants who underwent oesophagectomy with thoracoscopy met inclusion criteria [ 37 , 69 , 70 ]. All three studies evaluated the impact of exercise-based dysphagia interventions on swallow related outcomes in adults with oesophageal cancer.…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 5 cases had no relevant co-morbidities that may affect swallowing NI Thoracic “Oesophagectomy” RLNP ( n = 5. 1 of which was bilateral resulting in severe AP) Non-validated: VFSS rating tool suggested by Logemann, 1998 Takatsu et al, 2020 [ 70 ] Retrospective case control study Aichi Cancer Centre Hospital, Japan 276 CG; median 68 (IQR 64–74) TG; 69 (IQR 62–73) CG: 91/18 M:F TG: 142/25 M:F NI TNM Classification (UICC) -I/II CG: 49 (45%) TG: 56 (45%) -III/IV CG: 60 (55%) TG: 91 (55%) Thoracic CG: Neoadjuvant therapies: 87 (80%) Thoracoscopic oesophagectomy Open Oesophagectomy Cervical anastomosis TG: Neoadjuvant therapies: 133 (80%) Thoracoscopic oesophagectomy Open oesophagectomy Cervical anastomosis CG: RLNP 22 (20%) Pneumonia 25 (23%) AL: 8 (7%) TG: RLNP 34 (20%) Pneumonia 39 (23%) AL 22 (13%) 1. Start of oral intake 2.…”

Section: Resultsmentioning

confidence: 99%

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

et al. 2022

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Background Dysphagia is prevalent in oesophageal cancer with significant clinical and psychosocial complications. The purpose of this study was i) to examine the impact of exercise-based dysphagia rehabilitation on clinical and quality of life outcomes in this population and ii) to identify key rehabilitation components that may inform future research in this area. Methods Randomised control trials (RCT), non-RCTs, cohort studies and case series were included. 10 databases (CINAHL Complete, MEDLINE, EMBASE, Web of Science, CENTRAL, and ProQuest Dissertations and Theses, OpenGrey, PROSPERO, RIAN and SpeechBITE), 3 clinical trial registries, and relevant conference abstracts were searched in November 2020. Two independent authors assessed articles for eligibility before completing data extraction, quality assessment using ROBINS-I and Downs and Black Checklist, followed by descriptive data analysis. The primary outcomes included oral intake, respiratory status and quality of life. All comparable outcomes were combined and discussed throughout the manuscript as primary and secondary outcomes. Results Three single centre non-randomised control studies involving 311 participants were included. A meta-analysis could not be completed due to study heterogeneity. SLT-led post-operative dysphagia intervention led to significantly earlier start to oral intake and reduced length of post-operative hospital stay. No studies found a reduction in aspiration pneumonia rates, and no studies included patient reported or quality of life outcomes. Of the reported secondary outcomes, swallow prehabilitation resulted in significantly improved swallow efficiency following oesophageal surgery compared to the control group, and rehabilitation following surgery resulted in significantly reduced vallecular and pyriform sinus residue. The three studies were found to have ‘serious’ to ‘critical’ risk of bias. Conclusions This systematic review highlights a low-volume of low-quality evidence to support exercise-based dysphagia rehabilitation in adults undergoing surgery for oesophageal cancer. As dysphagia is a common symptom impacting quality of life throughout survivorship, findings will guide future research to determine if swallowing rehabilitation should be included in enhanced recovery after surgery (ERAS) programmes. This review is limited by the inclusion of non-randomised control trials and the reliance on Japanese interpretation which may have resulted in bias. The reviewed studies were all of weak design with limited data reported.

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“…Kinematic analyses have shown that there are changes to hyoid movement and location of the epiglottis after esophagectomy that affect swallowing (14). Rehabilitation programs which are instituted early after esophagectomy can alleviate these disorders, however (15).…”

Section: Left Crus Right Crusmentioning

confidence: 99%

Factors resulting in postoperative dysphagia following esophagectomy: a narrative review

Benz¹,

Martella²,

Hamwi³

et al. 2021

J Thorac Dis

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Esophagectomy is a technically involved surgery and can have significant postoperative morbidity. Although the mortality rate following esophagectomy has decreased in recent years, this surgical procedure has a relatively high complication rate compared to other surgeries to resect cancer. One of the most common complaints after esophagectomy is dysphagia. Dysphagia after esophagectomy can significantly affect quality of life. Dysphagia is a complication following esophagectomy that can lead to respiratory deterioration and death. The most common sites of postoperative dysphagia are the gastroesophageal anastomosis, gastric conduit, pylorus and the hiatus. Without appropriate treatment of dysphagia, malnutrition and dehydration can develop. These factors can lead to significant impacts to the overall health of a patient and increase mortality. A detailed literature review provided data to support diagnostic modalities and management strategies to treat postoperative dysphagia at these common areas. A systematic, evidencebased approach to diagnosis and treatment of postoperative dysphagia allows for prompt intervention and a decrease in morbidity and mortality. Treatment options for dysphagia vary, depending on the etiology. Based on the location and mechanism of dysphagia, options include stenting, dilation and surgical revision. Early treatment of dysphagia after esophagectomy can lessen the morbidity from this complication and improve quality of life.

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Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

Cited by 13 publications

References 36 publications

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Significance of Antimicrobial Prophylaxis for the Prevention of Early-Onset Pneumonia After Radical Esophageal Cancer Resection: A Retrospective Analysis of 356 Patients Undergoing Thoracoscopic Esophagectomy

Exercise-based dysphagia rehabilitation for adults with oesophageal cancer: a systematic review

Factors resulting in postoperative dysphagia following esophagectomy: a narrative review

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