Evaluation of dysphagia and diminished airway protection after three-field esophagectomy and a remedy.
BACKGROUND
Recently, reports from the West have indicated three-field lymphadenectomy (3FL) for esophageal cancer increases the accuracy of tumor staging and survival. However, this cervical procedure is likely to lead to swallowing dysfunction and aspiration, which are barriers to introducing this procedure in clinical practice.


METHODS
Our goal is to elucidate the etiology of swallowing dysfunction after 3FL and devise a remedy. First, based on evaluation of swallowing function in ten patients with two-field lymphadenectomy (2FL) and ten with 3FL, we hypothesized that the scarred sternohyoid and sternothyroid muscles might be impairing laryngeal elevation after 3FL; thus, complete division of the bilateral infrahyoid muscles attached to the sternum (CDBIMS) could be an effective remedy. Next, the utility of this additive procedure was examined in 20 patients with 3FL. Swallowing function was evaluated by the distance of total laryngeal elevation (TLE) and the frequency of incomplete airway protection (IAP) (laryngeal penetration or aspiration) on videofluoroscopic study.


RESULTS
The average TLE and frequency of IAP were, respectively, 0.37 cm and 70 % in the 3FL group, showing significant deterioration (p < 0.001 and 0.025), in contrast to 1.79 cm and 20 % in the 2FL group. The 3FL + CDBIMS group showed significant improvements in the average TLE and the frequency of IAP (1.70 cm and 25 %), compared with the 3FL group (p < 0.001 and 0.018). Multivariate logistic regression identified additive CDBIMS as a significant suppressor of IAP after 3FL.


CONCLUSIONS
Laryngeal elevation was significantly impaired after 3FL. Adding CDBIMS might improve swallowing function in these patients.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. tyasuda@surg.med.kindai.ac.jp
Takushi
T
Yasuda
Masahiko
M
Yano
Hiroshi
H
Miyata
Makoto
M
Yamasaki
Shuji
S
Takiguchi
Yoshiyuki
Y
Fujiwara
Yuichiro
Y
Doki
D000368:Aged; D059186:Chemoradiotherapy, Adjuvant; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D016015:Logistic Models; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D011788:Quality of Life; D053120:Respiratory Aspiration / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome