The prevalence, nature and trajectory of oropharyngeal dysphagia within the first year following curative open resection for esophageal cancer.

In the absence of a mechanical stricture, oropharyngeal dysphagia following esophageal cancer surgery, and swallowing physiology more broadly, is poorly understood. This study investigated oropharyngeal dysphagia within the first year following curative open esophageal resection. A prospective cohort study was conducted (January 2022 to January 2024) at the National Esophageal Cancer Centre in Ireland. Participants were recruited between 6 to 12 months post-esophagectomy. A standardized videofluoroscopy was completed. Outcome measures included the Dynamic Imaging Grade of Swallowing Toxicity (DIGESTv2), Modified Barium Swallow Impairment Profile (MBSImP), and Penetration-Aspiration Scale (PAS). Functional Oral Intake Scale (FOIS) was used to identify oral intake status. To evaluate the trajectory of oropharyngeal dysphagia, long-term data were compared to previously published acute data findings. Seventeen participants (12 males; mean age 65 years, range 46-80) were included. The cohort comprised transthoracic (2-stage n = 7, 3-stage n = 3) and transhiatal (n = 7) resections. 11 participants (65%) had persistent oropharyngeal dysphagia (DIGESTv2), and 2 (12%) continued to aspirate greater than 6-months, both of whom had a transhiatal resection. 10 (59%) continued to modify their diet (abnormal FOIS <7). MBSImP revealed impaired initiation of swallow (82%), anterior hyoid excursion (82%), tongue base retraction (100%), pharyngeal residue (100%) and neo-esophageal clearance (82%). When comparing acute to longer term data, there was a statistically significant difference in aspiration based on PAS (P = 0.016), but not dysphagia based on the DIGESTv2 (P = 0.500). Oropharyngeal dysphagia is prevalent within the first year following open esophageal cancer surgery. The study informs the need for structured guidelines and a swallowing care pathway.