Purpose: The purposes of this study are to assess the usefulness of bedside swallowing tests and identify the clinical risk factors for subglottic aspiration after esophagectomy in esophageal cancer patients.
Methods: The study included patients who underwent esophagectomy for esophageal cancer between January and August 2013. Videofluoroscopic swallowing study (VFSS) was carried out 7 to 10 days post-surgery, and clinical bedside swallowing tests were conducted to determine the risk factors for subglottic aspiration.
Results: A total of 118 patients were evaluated, 38 of whom (32.2%) showed evidence of subglottic aspiration on VFSS. The clinical bedside swallowing test yielded positive results in 26 of the 38 patients with subglottic aspiration (sensitivity 68.4%). Prolonged operation time and vocal cord paralysis were risk factors predicting aspiration in multiple logistic regression analysis (odds ratio (OR), 0.651 per hour; P = 0.017 and OR, 9.1; P < 0.001). When operation times were divided into two groups, greater than or equal to 6 h (≥6 h) and less than 6 h (<6 h), the OR of operation time ≥6 h to aspiration was increased to 3.22 (P = 0.007).
Conclusions: We found that the clinical bedside swallowing test had a sensitivity of 68.4%, which, without VFSS, was insufficient to detect subglottic aspiration. Operation time greater than or equal to 6 h and vocal cord paralysis were risk factors for subglottic aspiration. Therefore, VFSS should be recommended in esophageal cancer patients who have operation time greater than or equal to 6 h or have vocal cord paralysis after esophagectomy.
Keywords: Clinical bedside swallowing tests; Dysphagia; Esophageal cancer; Esophagectomy; Videofluoroscopic swallowing study.