Rehabilitation Approaches for Various Types of Dysphagia after Esophageal Cancer Surgery

Abstract

: There are no reports reviewing the various types of dysphagia that occur after surgery for esophageal cancer and the rehabilitation approaches appropriate for each type. Herein, we classi ed various types of dysphagia after esophageal cancer surgery according to cause and examined the rehabilitation approaches for each type, as well as the outcomes. The study was performed on 31 patients who were tested postoperatively for swallowing function and underwent rehabilitation for dysphagia during their hospitalization. In patients with decreased swallowing ability due to recurrent laryngeal nerve injury associated with lymph node dissection, oral intake ability was improved by basic and feeding exercises. In patients with markedly reduced laryngeal elevation detected by videofluoroscopic examination of swallowing, feeding exercises were performed in addition to basic exercises that centered on stretching the perilaryngeal muscles. Improvements in laryngeal elevation were observed in some patients. In patients with dysphagia caused by postoperative gastrointestinal GI anastomotic stricture, the balloon dilatation method using an upper GI endoscope was applied at the anastomotic site. Finally, in patients with retention and re ux of GI tract contents in whom the re ux of contents into the pharynx caused aspiration, postures unlikely to cause re ux were maintained. Thus, dysphagia after esophageal cancer surgery may be due to not only swallowing dysfunction, but also impairments of the GI tract. When ingestion and swallowing abilities are assessed, simultaneous video uoroscopic examination of swallowing and an upper GI series are important. In some cases, standard rehabilitation techniques alone may not be sufficient, requiring a multimodal approach for effective treatment.