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Article: Long-term pharyngeal dysphagia after esophagectomy for esophageal cancer - an investigation using videofluoroscopic swallow studies

TitleLong-term pharyngeal dysphagia after esophagectomy for esophageal cancer - an investigation using videofluoroscopic swallow studies
Authors
Keywordsaspiration
cancer surgery
clinical article
coughing
disease association
Issue Date2019
PublisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/DES
Citation
Diseases of the Esophagus, 2019, v. 32 n. 1, article no. doy068 How to Cite?
AbstractDysphagia is a common symptom of esophageal cancer (EC). Esophagectomy should relieve the presenting dysphagia as the mechanical obstruction caused by the tumor is removed. However, the new onset oropharyngeal dysphagia develops after esophagectomy and the deficit may persist increasing the risk of aspiration pneumonia and mortality as well as adversely affecting quality of life (QOL). This study investigates the persistent swallowing deficits in long-term postesophagectomy patients and explores the factors associated with dysphagia severity, penetration, and aspiration. A better understanding of the swallowing function can aid future management of the condition. A total of 29 patients who were more than six months postesophagectomy for EC, had no history of disease that would likely affect swallowing function or vocal cord palsy underwent detailed videofluoroscopic swallow studies and completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and OES18 QOL questionnaires. Swallowing deficits were analyzed and rated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). These variables were correlated with the clinical and QOL parameters to determine which factors would affect swallowing function. Our cohort consisted of 27 males and 2 females. The mean duration after esophagectomy when the swallowing study was performed was 3.2 years (range: 0.5–18.4 years). Swallowing deficits were mainly found in the pharyngeal phase of swallowing. The mean total VDS score was 36.1 (SD = 15.2, range: 11.0–69.5) out of a possible 100. The mean PAS score was 4.1 (SD = 2.5, range: 1–8) and 1.5 (SD = 0.9, range: 1–4) for thin and semisolids, respectively. Dysphagia was significantly more severe in males, those of more advanced age at esophagectomy and at swallowing assessment. Increasing pathological N stage significantly correlated with worse PAS score for thin fluid. Self-reports of more pain and less troubles with coughing were also associated with less penetration and aspiration. This study demonstrated that a mild to moderate pharyngeal dysphagia is present late after esophagectomy even in patients without VC palsy or anastomotic stricture. The long-term aspiration rate is comparable to the figures in the literature for those early after esophagectomy. It is suggested that damage to the intercostal nerves and the pulmonary vagus may affect oropharyngeal swallowing function in this population.
Persistent Identifierhttp://hdl.handle.net/10722/272704
ISSN
2023 Impact Factor: 2.3
2023 SCImago Journal Rankings: 1.038
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYuen, MTY-
dc.contributor.authorTsang, RK-
dc.contributor.authorWong, YH-
dc.contributor.authorChan, DKK-
dc.contributor.authorChan, FSY-
dc.contributor.authorLaw, SYK-
dc.date.accessioned2019-08-06T09:14:58Z-
dc.date.available2019-08-06T09:14:58Z-
dc.date.issued2019-
dc.identifier.citationDiseases of the Esophagus, 2019, v. 32 n. 1, article no. doy068-
dc.identifier.issn1120-8694-
dc.identifier.urihttp://hdl.handle.net/10722/272704-
dc.description.abstractDysphagia is a common symptom of esophageal cancer (EC). Esophagectomy should relieve the presenting dysphagia as the mechanical obstruction caused by the tumor is removed. However, the new onset oropharyngeal dysphagia develops after esophagectomy and the deficit may persist increasing the risk of aspiration pneumonia and mortality as well as adversely affecting quality of life (QOL). This study investigates the persistent swallowing deficits in long-term postesophagectomy patients and explores the factors associated with dysphagia severity, penetration, and aspiration. A better understanding of the swallowing function can aid future management of the condition. A total of 29 patients who were more than six months postesophagectomy for EC, had no history of disease that would likely affect swallowing function or vocal cord palsy underwent detailed videofluoroscopic swallow studies and completed the European Organisation for Research and Treatment of Cancer QLQ-C30 and OES18 QOL questionnaires. Swallowing deficits were analyzed and rated using the videofluoroscopic dysphagia scale (VDS) and the penetration-aspiration scale (PAS). These variables were correlated with the clinical and QOL parameters to determine which factors would affect swallowing function. Our cohort consisted of 27 males and 2 females. The mean duration after esophagectomy when the swallowing study was performed was 3.2 years (range: 0.5–18.4 years). Swallowing deficits were mainly found in the pharyngeal phase of swallowing. The mean total VDS score was 36.1 (SD = 15.2, range: 11.0–69.5) out of a possible 100. The mean PAS score was 4.1 (SD = 2.5, range: 1–8) and 1.5 (SD = 0.9, range: 1–4) for thin and semisolids, respectively. Dysphagia was significantly more severe in males, those of more advanced age at esophagectomy and at swallowing assessment. Increasing pathological N stage significantly correlated with worse PAS score for thin fluid. Self-reports of more pain and less troubles with coughing were also associated with less penetration and aspiration. This study demonstrated that a mild to moderate pharyngeal dysphagia is present late after esophagectomy even in patients without VC palsy or anastomotic stricture. The long-term aspiration rate is comparable to the figures in the literature for those early after esophagectomy. It is suggested that damage to the intercostal nerves and the pulmonary vagus may affect oropharyngeal swallowing function in this population.-
dc.languageeng-
dc.publisherWiley-Blackwell Publishing Asia. The Journal's web site is located at http://www.blackwellpublishing.com/journals/DES-
dc.relation.ispartofDiseases of the Esophagus-
dc.rightsThis is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.-
dc.subjectaspiration-
dc.subjectcancer surgery-
dc.subjectclinical article-
dc.subjectcoughing-
dc.subjectdisease association-
dc.titleLong-term pharyngeal dysphagia after esophagectomy for esophageal cancer - an investigation using videofluoroscopic swallow studies-
dc.typeArticle-
dc.identifier.emailTsang, RK: rkytsang@hku.hk-
dc.identifier.emailWong, YH: iyhwong@hku.hk-
dc.identifier.emailChan, FSY: fsychan@hku.hk-
dc.identifier.emailLaw, SYK: slaw@hku.hk-
dc.identifier.authorityTsang, RK=rp01386-
dc.identifier.authorityWong, YH=rp02293-
dc.identifier.authorityLaw, SYK=rp00437-
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.1093/dote/doy068-
dc.identifier.pmid30085000-
dc.identifier.scopuseid_2-s2.0-85059244348-
dc.identifier.hkuros300942-
dc.identifier.volume32-
dc.identifier.issue1-
dc.identifier.spagearticle no. doy068-
dc.identifier.epagearticle no. doy068-
dc.identifier.isiWOS:000461509700009-
dc.publisher.placeAustralia-
dc.identifier.issnl1120-8694-

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