Department of Rehabilitation, Aichi Cancer Center Hospital, Nagoya 464-8681, Japan.
Department of Speech Pathology, Aichi-Gakuin University,Nisshin, 470-0195, Japan.
Dis Esophagus. 2021 May 22;34(5). doi: 10.1093/dote/doaa094.
Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech-language-hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient's dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient's subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.
食管癌术后吞咽困难是导致术后住院时间延长的主要原因。本研究探讨了由言语-语言治疗师（SLHT）领导的吞咽干预对术后吞咽困难的影响。我们纳入了 2015 年 7 月至 2018 年 12 月期间接受食管癌切除术和颈段食管胃吻合术的 276 例连续食管癌患者；109 例接受标准护理（对照组），167 例接受吞咽干预（干预组）。在干预组中，由 SLHT 根据每位患者的功能障碍进行吞咽功能筛查和康复。比较两组患者的开始口服摄入时间、口服摄入康复时间和术后住院时间。在 276 例患者的亚组中检查，以明确干预的更有效性。干预组患者的开始口服摄入时间显著更早（POD：11 天比 8 天；P=0.009）。在亚组分析中，吞咽干预还显著缩短了无并发症患者（POD：18 天比 14 天；P=0.001）和喉返神经麻痹（RLNP）患者（POD：30 天比 21.5 天；P=0.003）的术后住院时间。多变量回归分析确定吞咽干预是无并发症和 RLNP 患者更早开始口服摄入和缩短术后住院时间的显著独立因素。我们提出的吞咽干预对食管癌术后更早开始口服摄入和出院有益，特别是在无并发症和 RLNP 的患者中。该方案可能有助于术后快速康复。
