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Original research
Swallowing dysfunction after minimally invasive oesophagectomy
  1. Della Mann1,
  2. Jennifer H Benbow2,
  3. Nicole L Gower2,
  4. Sally Trufan3,
  5. Michael Watson4,
  6. Madison E Colcord2,
  7. Malcolm H Squires4,
  8. Vishwa S Raj5,6,
  9. Joshua S Hill4 and
  10. Jonathan C Salo4
  1. 1 Department of Supportive Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
  2. 2 LCI Research Support, Levine Cancer Institute, Charlotte, North Carolina, USA
  3. 3 Department of Biostatistics, Levine Cancer Institute, Charlotte, North Carolina, USA
  4. 4 Department of Surgery, Levine Cancer Institute, Charlotte, North Carolina, USA
  5. 5 Department of Physical Medicine & Rehabilitation, Levine Cancer Institute, Charlotte, North Carolina, USA
  6. 6 Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina, USA
  1. Correspondence to Dr Jonathan C Salo, Department on Surgery, Levine Cancer Institute, Charlotte, NC 28204, USA; Jonathan.Salo{at}atriumhealth.org

Abstract

Objectives Patients undergoing oesophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires preservation of muscle mass. Swallowing dysfunction puts postoperative patients at risk for aspiration and pneumonia. Modified Barium Swallow Study (MBSS) enables assessment of postoperative swallowing impairments. The current study assessed incidence and risk factors associated with swallowing dysfunction and restricted diet at discharge in patients after oesophagectomy in a high-volume surgical centre.

Methods Patients with an MBSS after oesophagectomy were identified between March 2015 to April 2020 at a high-volume surgical centre. Swallowing was quantitatively evaluated on MBSS with the Rosenbek Penetration-Aspiration Scale (PAS). Muscle loss was evaluated clinically with preoperative hand grip strength (HGS). Univariable and multivariable logistic and linear regression analyses were performed.

Results 129 patients (87% male; median age 66 years) underwent oesophagectomy with postoperative MBSS. Univariate analysis revealed older age, preoperative feeding tube, lower preoperative HGS and discharge to non-home were associated with aspiration or penetration on MBSS. Age and preoperative feeding tube remained as independent predictors in the multivariable analysis. Both univariate and multivariable analyses revealed increased age and preoperative feeding tube were associated with diet restrictions at discharge.

Conclusions Swallowing dysfunction after oesophagectomy is correlated with increased age and need for preoperative enteral feeding tube placement. Further research is needed to understand the relationship between muscle loss and aspiration with the goal of enabling preoperative physiological optimisation and patient selection.

  • clinical assessment
  • clinical decisions
  • dysphagia
  • gastrointestinal (upper)

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

https://doi.org/10.1136/bmjspcare-2020-002626

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as online supplemental information.

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    Footnotes

    • Contributors DM, JB, NLG, MW, MC, MHS, VR, JH and JCS contributed to the conception/design of the work; DM, JB, NLG, MC, ST and JCS contributed to the acquisition of data; ST and JCS contributed to the analysis/interpretation of the data; DM, ST, JB and JCS drafted the manuscript; all authors critically revised the manuscript for intellectual content; all authors approved the final version submitted and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.