title: Prospective Comprehensive Swallowing Evaluation of Minimally Invasive Esophagectomies with Cervical Anastomosis: Silent Versus Vocal Aspiration.
abstract: BACKGROUND
  Pneumonia and tracheal aspiration remain problematic following esophagectomy. We hypothesized that the incidence of postesophagectomy pneumonia occurs in part because of swallowing dysfunction and more importantly silent tracheobronchial aspiration. Therefore, we instituted a routine prospective formal swallowing evaluation to determine if the aspiration rate and its associated morbidity can be decreased by early identification of patients with silent or vocal aspiration.
  
  
  METHODS
  Patients undergoing minimally invasive McKeown esophagectomy and receiving neoadjuvant chemoradiotherapy (NACR) were prospectively enrolled between December 2013 to January 2015. A standardized cineradiography observation utilizing the Rosenbek penetration-aspiration (RPA) scale was used to rule out anastomotic leak and/or aspiration.
  
  
  RESULTS
  Of 27 patients evaluated, twelve patients were noted to have silent (n = 8) or vocal (cough n = 4) aspiration of thin liquid (n = 8) or nectar-thick consistency (n = 4) on their initial study. Three patients were noted to have an anastomotic leak and vocal aspiration on their initial study. Eight of the nine patients who aspirated but did not have an anastomotic leak on their initial study had a repeat RPA study prior to discharge showing improvement from the initial study. Six patients (22 %) had vocal cord paresis and clinical hoarseness, but only two patients who had clinical diagnosis of pneumonia were noted to have vocal cord paresis and silent aspiration.
  
  
  CONCLUSIONS
  Swallowing dysfunction remains a common problem after minimally invasive esophagectomy (MIE) with cervical anastomosis and can be readily identified. Silent aspiration likely contributes to pneumonia after MIE.
authors.affiliation: Mount Sinai Medical Center, Miami Beach, FL, USA. kfir.bendavid@MSMC.com.
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
authors.affiliation: Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Fullerton
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Georgios
authors.initials: G
authors.lastname: Rossidis
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Michel
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Thomas
authors.affiliation: Department of Surgery, University of Florida, Gainesville, FL, USA.
authors.forename: George
authors.initials: G
authors.lastname: Sarosi
authors.affiliation: Department of Anesthesia, University of Florida, Gainesville, FL, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: White
authors.affiliation: Department of Anesthesia, University of Florida, Gainesville, FL, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Giordano
authors.affiliation: Department of Surgery, Roswell Park Cancer Center, Buffalo, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Hochwald
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009333:Neck / Q000601:surgery*; D011446:Prospective Studies
keywords: Aspiration; Cervical anastomosis; Minimally invasive esophagectomies; Swallowing evaluation