Videofluoroscopic evaluation of pharyngeal swallowing dysfunction after esophagectomy with three-field lymph node dissection.

Abstract

To determine the factors inducing aspiration following esophagectomy with three-field lymph node dissection (3FL) and the effect of the chin-down maneuver combined with supraglottic swallow (CDSS). Retrospective analysis of a consecutive case series. Videofluoroscopic (VF) evaluations of 25 patients who consulted with our out-patient clinic from 2006 to 2012 for swallowing dysfunction following esophagectomy with 3FL without tracheostomy were reviewed. The penetration aspiration scale (PAS) was used for evaluation. The assessment parameters of VF examination were set as follows: laryngeal elevation, peristaltic wave of the pharynx, upper esophageal sphincter opening, and bolus residue in the pyriform sinus and vallecula after swallowing. Associations of the degree of aspiration with these parameters and the effect of CDSS maneuver on PAS were statistically examined. Fourteen patients had swallowing dysfunction with PAS score (1-3). Disturbance of laryngeal elevation was significantly correlated with the degree of aspiration (p=0.021). Multivariate logistic regression analysis demonstrated that reduced laryngeal elevation significantly enhanced aspiration (p=0.0026). Sixteen patients had already acquired compensated chin-down swallowing at the time of VF (Group I). Among the remaining nine patients (Group II), the PAS score was significantly (p<0.05) improved after training in chin-down swallowing. The mean PAS score of the Group I patients was not significantly different from that of the Group II patients after the training in CDSS. Laryngeal aspiration following esophagectomy with 3FL is significantly correlated with reduced laryngeal elevation and can be ameliorated after training in CDSS. Level of evidence IV.