Seung Yeol Lee1, Hee-Jung Cheon1, Sang Jun Kim1, Young Mog Shim2, Jae Ill Zo2, Ji Hye Hwang3. 1. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. 2. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. 3. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. hwanglee@skku.edu.
Abstract
PURPOSE: The purposes of this study are to assess the usefulness of bedside swallowing tests and identify the clinical risk factors for subglottic aspiration after esophagectomy in esophageal cancer patients. METHODS: The study included patients who underwent esophagectomy for esophageal cancer between January and August 2013. Videofluoroscopic swallowing study (VFSS) was carried out 7 to 10 days post-surgery, and clinical bedside swallowing tests were conducted to determine the risk factors for subglottic aspiration. RESULTS: A total of 118 patients were evaluated, 38 of whom (32.2%) showed evidence of subglottic aspiration on VFSS. The clinical bedside swallowing test yielded positive results in 26 of the 38 patients with subglottic aspiration (sensitivity 68.4%). Prolonged operation time and vocal cord paralysis were risk factors predicting aspiration in multiple logistic regression analysis (odds ratio (OR), 0.651 per hour; P = 0.017 and OR, 9.1; P < 0.001). When operation times were divided into two groups, greater than or equal to 6 h (≥6 h) and less than 6 h (<6 h), the OR of operation time ≥6 h to aspiration was increased to 3.22 (P = 0.007). CONCLUSIONS: We found that the clinical bedside swallowing test had a sensitivity of 68.4%, which, without VFSS, was insufficient to detect subglottic aspiration. Operation time greater than or equal to 6 h and vocal cord paralysis were risk factors for subglottic aspiration. Therefore, VFSS should be recommended in esophageal cancer patients who have operation time greater than or equal to 6 h or have vocal cord paralysis after esophagectomy.
PURPOSE: The purposes of this study are to assess the usefulness of bedside swallowing tests and identify the clinical risk factors for subglottic aspiration after esophagectomy in esophageal cancerpatients. METHODS: The study included patients who underwent esophagectomy for esophageal cancer between January and August 2013. Videofluoroscopic swallowing study (VFSS) was carried out 7 to 10 days post-surgery, and clinical bedside swallowing tests were conducted to determine the risk factors for subglottic aspiration. RESULTS: A total of 118 patients were evaluated, 38 of whom (32.2%) showed evidence of subglottic aspiration on VFSS. The clinical bedside swallowing test yielded positive results in 26 of the 38 patients with subglottic aspiration (sensitivity 68.4%). Prolonged operation time and vocal cord paralysis were risk factors predicting aspiration in multiple logistic regression analysis (odds ratio (OR), 0.651 per hour; P = 0.017 and OR, 9.1; P < 0.001). When operation times were divided into two groups, greater than or equal to 6 h (≥6 h) and less than 6 h (<6 h), the OR of operation time ≥6 h to aspiration was increased to 3.22 (P = 0.007). CONCLUSIONS: We found that the clinical bedside swallowing test had a sensitivity of 68.4%, which, without VFSS, was insufficient to detect subglottic aspiration. Operation time greater than or equal to 6 h and vocal cord paralysis were risk factors for subglottic aspiration. Therefore, VFSS should be recommended in esophageal cancerpatients who have operation time greater than or equal to 6 h or have vocal cord paralysis after esophagectomy.
Authors: Anna Gillman; Michelle Hayes; Greg Sheaf; Margaret Walshe; John V Reynolds; Julie Regan Journal: BMC Cancer Date: 2022-01-10 Impact factor: 4.430