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

Abstract

Abstract Aim Dysphagia is one of the most common complications after esophagectomy. However, no study has investigated the long‐term postoperative outcomes in patients with postoperative dysphagia. Here, we aimed to identify risk factors for postoperative dysphagia and to investigate long‐term postoperative outcomes in such patients. Methods This study included 304 consecutive patients with thoracic esophageal cancer who underwent curative esophagectomy. They were diagnosed with postoperative dysphagia through a contrast videofluoroscopic swallowing study, and postoperative outcomes were compared based on swallowing function. Results In total, 112 patients (37%) were diagnosed with postoperative dysphagia. Older age, low BMI, and recurrent laryngeal nerve palsy were identified as independent risk factors for postoperative dysphagia. In the dysphagia group, a significantly larger number of patients developed in‐hospital pneumonia, and hospital stays were also significantly extended. After discharge, 37 (33%) patients with postoperative dysphagia developed pneumonia. Even more than 1 year after esophagectomy, a significantly larger number of patients (24 patients, 21%) with postoperative dysphagia developed pneumonia compared to those without postoperative dysphagia. Postoperative dysphagia was identified as an independent risk factor for out‐of‐hospital pneumonia. Regarding nutritional status, there was no difference in weight loss 1 year after esophagectomy, but significant weight loss was observed 2 years after esophagectomy in the dysphagia group. Conclusion Postoperative dysphagia was associated with both preoperative patient factors and surgical factors. Moreover, patients with postoperative dysphagia had long‐term and short‐term pneumonia risk. The personalization of long‐term follow‐up through more aggressive rehabilitation and nutritional guidance is required for patients with postoperative dysphagia.

Keywords

• dysphagia
• esophageal cancer
• esophagectomy
• pneumonia
• recurrent laryngeal nerve palsy