Fujiwara Kazunori, Taira Kenkichiro, Donishi Ryohei, Koyama Satoshi, Morisaki Tsuyoshi, Fukuhara Takahiro, Takeuchi Hiromi
Division of Otolaryngology, Head and Neck Surgery, Department of Sensory and Motor Organs, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan.
Int J Clin Oncol. 2021 May;26(5):835-840. doi: 10.1007/s10147-021-01860-9. Epub 2021 Jan 18.
Transoral surgery (TOS) has been used to remove pharyngeal and laryngeal cancers with the objective of improving functional without worsening survival. However, there is a risk of postoperative dysphagia, which can severely impair quality of life. The aim of this study was to evaluate the preoperative predictive factors for postoperative dysphagia in patients undergoing TOS.
One hundred and twenty patients who underwent TOS were evaluated in this study. The degree of dysphagia was evaluated using the Functional Outcome Swallowing Scale (FOSS) both preoperatively and 3 months postoperatively. Those whose FOSS stage was maintained postoperatively were classified into the FOSS-M group, while those with increased FOSS stage postopratively were classified into the FOSS-I group. The following parameters were assessed before surgery: age, weight, height, body mass index (BMI), forced expiratory volume in 1 s, and history of head and neck radiotherapy. Videofluoroscopy (VF) was performed preoperatively to evaluate swallowing function using the Penetration-Aspiration Scale (PAS).
The BMI of the FOSS-M group was significantly higher than that of the FOSS-I group. A history of radiotherapy was significantly more common in the FOSS-I group than in the FOSS-M group. Finally, preoperative PAS in the FOSS-M group was lower than that in the FOSS-I group.
This study suggested that patients with preoperative aspiration detected using VF might develop postoperative dysphagia severely. In addition, preoperative low BMI and a history of previous radiotherapy for head and neck cancer were associated with postoperative dysphagia. Objective examinations such as VF should be performed preoperatively.
经口手术（TOS）已被用于切除咽喉部癌症，目的是在不降低生存率的情况下改善功能。然而，存在术后吞咽困难的风险，这可能严重损害生活质量。本研究的目的是评估接受TOS手术患者术后吞咽困难的术前预测因素。
本研究评估了120例接受TOS手术的患者。术前和术后3个月使用功能吞咽结果量表（FOSS）评估吞咽困难程度。术后FOSS分期维持不变的患者被归类为FOSS-M组，而术后FOSS分期增加的患者被归类为FOSS-I组。术前评估以下参数：年龄、体重、身高、体重指数（BMI）、一秒用力呼气量以及头颈部放疗史。术前进行视频荧光吞咽造影（VF），使用渗透-误吸量表（PAS）评估吞咽功能。
FOSS-M组的BMI显著高于FOSS-I组。放疗史在FOSS-I组中比在FOSS-M组中更常见。最后，FOSS-M组的术前PAS低于FOSS-I组。
本研究表明，术前通过VF检测出有误吸的患者术后可能会出现严重的吞咽困难。此外，术前低BMI以及既往有头颈部癌放疗史与术后吞咽困难有关。术前应进行VF等客观检查。
