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Swallowing dysfunction after minimally invasive oesophagectomy.

Della Mann1, Jennifer H Benbow2, Nicole L Gower2

  • 1Department of Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA.

BMJ Supportive & Palliative Care
|October 23, 2020
PubMed
Summary

Older age and needing a preoperative feeding tube are linked to swallowing problems after oesophagectomy (esophageal surgery). These factors also predict diet restrictions upon discharge, impacting patient recovery.

Keywords:
clinical assessmentclinical decisionsdysphagiagastrointestinal (upper)

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Area of Science:

  • Otorhinolaryngology
  • Gastroenterology
  • Surgical Oncology

Background:

  • Oesophagectomy patients often face malnutrition and muscle loss, compromising swallowing function and increasing aspiration risk.
  • Swallowing dysfunction post-surgery can lead to aspiration pneumonia, a serious complication.
  • Modified Barium Swallow Study (MBSS) is crucial for assessing postoperative swallowing impairments.

Purpose of the Study:

  • To determine the incidence of swallowing dysfunction and diet restrictions at discharge following oesophagectomy.
  • To identify risk factors associated with postoperative swallowing impairments and dietary limitations.

Main Methods:

  • Retrospective analysis of 129 patients undergoing oesophagectomy between March 2015 and April 2020.
  • Quantitative swallowing evaluation using the Rosenbek Penetration-Aspiration Scale (PAS) on MBSS.
  • Assessment of muscle loss via preoperative hand grip strength (HGS) and statistical regression analyses.

Main Results:

  • Older age and preoperative feeding tube use were independent predictors of aspiration/penetration on MBSS.
  • Increased age and preoperative feeding tube requirement were associated with diet restrictions at discharge.
  • Lower preoperative hand grip strength and discharge to non-home settings were linked to aspiration/penetration in univariate analysis.

Conclusions:

  • Swallowing dysfunction after oesophagectomy is significantly correlated with patient age and the necessity for preoperative enteral feeding.
  • Further investigation into the muscle loss-aspiration relationship is warranted for preoperative optimization and patient selection.