Risk factors and long‐term postoperative outcomes in patients with postoperative dysphagia after esophagectomy for esophageal cancer

Sugase, Takahito; Miyata, Hiroshi; Sugimura, Keijiro; Kanemura, Takashi; Takeoka, Tomohira; Yamamoto, Masaaki; Shinno, Naoki; Hara, Hisashi; Omori, Takeshi; Yano, Masahiko

doi:10.1002/ags3.12566

Cited by 5 publications

(13 citation statements)

References 26 publications

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“… 21 In addition, patients with esophageal cancer often develop various postoperative complications, such as dysphagia, pneumonia, micronutrient malnutrition, and weight loss. 16 , 22 , 23 They may have an increased risk of developing osteoporosis after esophagectomy. However, BMD changes in postoperative patients with esophageal cancer have not been evaluated well.…”

Section: Discussionmentioning

confidence: 99%

“…Pickhardt et al demonstrated that trabecular attenuation values for the vertebral bodies on CT scans could be used to estimate BMD. 16 , 17 Because normative ranges for L1 trabecular attenuation have been established for all ages, direct HU measurements from diagnostic CT scans can be helpful and reliable for opportunistic use in osteoporosis screening. 24 Third, although we revealed the incidence of osteoporosis after esophagectomy, we could not investigate bone fracture and the long‐term quality of life in patients with osteoporosis after esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Habitual alcohol consumption and smoking are the most common risk factors for esophageal cancer 21 . In addition, patients with esophageal cancer often develop various postoperative complications, such as dysphagia, pneumonia, micronutrient malnutrition, and weight loss 16,22,23 . They may have an increased risk of developing osteoporosis after esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

“… 15 Postoperative dysphagia was evaluated by a videofluoroscopic swallowing study as previously described. 16 The rate of weight change was assessed relative to the preoperative weight. Since the median weight change at 1‐year after surgery was 88% in the present study, we defined severe weight loss as ≤85% weight change between the time of surgery and post‐surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Postoperative complications were assessed by the Clavien–Dindo classification 15 . Postoperative dysphagia was evaluated by a videofluoroscopic swallowing study as previously described 16 . The rate of weight change was assessed relative to the preoperative weight.…”

Section: Methodsmentioning

confidence: 99%

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Long‐term changes in bone mineral density in postoperative patients with esophageal cancer

Sugase

Sugimura

Kanemura

et al. 2022

Annals of Gastroent Surgery

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Aim The aim of this study was to investigate long‐term changes in bone mineral density (BMD) after esophagectomy, identify the risk factors for postoperative osteoporosis in patients with esophageal cancer and survival outcomes related to osteoporosis. Methods We retrospectively evaluated BMD changes for 197 consecutive patients with thoracic esophageal cancer who were disease‐free for 5 years after radical esophagectomy. Osteoporosis was diagnosed using computed tomography with an L1 attenuation threshold of ≤110 HU. Survival analysis was performed on 381 consecutive patients with 5‐year follow‐up after radical esophagectomy. Results BMD decreased annually after esophagectomy. The median attenuation (HU) was 134.2 before surgery and 135.2, 127.4, 123.3, 115.2, 105.6, and 102.4 at 6 months and 1, 2, 3, 4, and 5 years after surgery, respectively. Osteoporosis was diagnosed in 25.9% patients before surgery and 23.3%, 29.4%, 40.1%, 46.7%, 54.8%, and 60.4% patients with osteoporosis were observed at 6 months and 1, 2, 3, 4, and 5 years after surgery, respectively. Postoperative BMD did not decrease in patients aged ≤54 years, those who had never been smokers, and those with no weight loss after esophagectomy. Multivariate analysis identified that age (≥65 years) at surgery and smoking history were independent risk factors for osteoporosis at 5 years after esophagectomy. Patients with preoperative osteoporosis tended to have worse prognosis in disease‐free survival and overall survival than those without osteoporosis, who were more likely to die due to non‐esophageal cancer. Conclusion Esophageal cancer survivors are more likely to develop osteoporosis after esophagectomy, and preoperative osteoporosis might be associated with prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Long‐term changes in bone mineral density in postoperative patients with esophageal cancer

Sugase

Sugimura

Kanemura

et al. 2022

Annals of Gastroent Surgery

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Longitudinal Analysis of Dysphagia and Factors Related to Postoperative Pneumonia in Patients Undergoing Esophagectomy for Esophageal Cancer

Kaneoka,

Inokuchi,

Ueha

et al. 2023

Dysphagia

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Few studies have quantified longitudinal changes in swallowing in patients undergoing esophagectomy for esophageal cancer. This study longitudinally analyzed the changes in the Modified Barium Swallow Study Impairment Profile (MBSImP™) scores, swallowing kinematic measurements, and swallowing-related symptoms in patients undergoing esophagectomy. We also examined the association between identified swallowing impairment and aspiration pneumonia after surgery. We included consecutive patients who underwent esophagectomy and completed laryngoscopy and videofluoroscopy before, two weeks, and three months after surgery. We analyzed physiological impairments using the MBSImP. We also assessed the swallowing kinematics on a 5 mL thickened liquid bolus at three time points. Vocal fold mobility was assessed using a laryngoscope. Repeated measures were statistically examined for longitudinal changes in swallowing function. The association between the significant changes identified after esophagectomy and aspiration pneumonia was tested. Twenty-nine patients were included in this study. Preoperative swallowing function was intact in all participants. The timing of swallowing initiation and opening of the pharyngoesophageal segment remained unchanged after surgery. Tongue base retraction and pharyngeal constriction ratio worsened two weeks after surgery but returned to baseline levels three months after surgery. Three months after surgery, hyoid displacement and vocal fold immobility did not fully recover. Aspiration pneumonia occurred in nine patients after surgery and was associated with postoperative MBSImP pharyngeal residue scores. Decreased hyoid displacement and vocal fold immobility were observed postoperatively and persisted for a long time. The postoperative pharyngeal residue was associated with pneumonia and thus should be appropriately managed after surgery.

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Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

Shiomi,

Yagi,

Iwata

et al. 2023

Surg Endosc

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Background Lymphatic flow mapping using near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) has been used for the intraoperative prediction of lymph node metastasis in esophageal or esophagogastric junction cancer. However, a consistent method that yields sufficient diagnostic quality is yet to be confirmed. This study explored the diagnostic utility of our newly established lymphatic flow mapping protocol for predicting lymph node metastasis in patients with esophageal or esophagogastric junction cancer. Methods We injected 0.5 mL of ICG (500 μg/mL) into the submucosal layer at four peritumoral points on the day before surgery for 54 patients. We performed lymphatic flow mapping intraoperatively using NIR imaging. After determining the NIR status and presence of metastases, evaluable lymph node stations on in vivo imaging and all resected lymph nodes were divided into four categories: ICG+meta+ (true positive), ICG+meta− (false positive), ICG−meta+ (false negative), and ICG−meta− (true negative). Results The distribution of ICG+ and meta+ lymph node stations differed according to the primary tumor site. Sensitivity and specificity for predicting meta+ lymph nodes among ICG+ ones were 50% (95% CI 41–59%) and 75% (73–76%), respectively. Predicting meta+ lymph node stations among ICG+ stations improved these values to 66% (54–77%) and 77% (74–79%), respectively. Undergoing neoadjuvant chemotherapy was an independent risk factor for having meta+ lymph nodes with false-negative diagnoses (odds ratio 4.82; 95% CI 1.28–18.19). The sensitivity of our technique for predicting meta+ lymph nodes and meta+ lymph node stations in patients who did not undergo neoadjuvant chemotherapy was 79% (63–90%) and 83% (61–94%), respectively. Conclusion Our protocol potentially helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer undergoing esophagectomy who did not undergo neoadjuvant chemotherapy. Graphical abstract

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Risk factors and long‐term postoperative outcomes in patients with postoperative dysphagia after esophagectomy for esophageal cancer

Cited by 5 publications

References 26 publications

Long‐term changes in bone mineral density in postoperative patients with esophageal cancer

Long‐term changes in bone mineral density in postoperative patients with esophageal cancer

Longitudinal Analysis of Dysphagia and Factors Related to Postoperative Pneumonia in Patients Undergoing Esophagectomy for Esophageal Cancer

Lymphatic flow mapping using near-infrared fluorescence imaging with indocyanine green helps to predict lymph node metastasis intraoperatively in patients with esophageal or esophagogastric junction cancer not treated with neoadjuvant chemotherapy

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