Oropharyngeal dysphagia in esophageal cancer before and after transhiatal esophagectomy

Although dysphagia is the predominant symptom of esophageal cancer, the nat ure of the swallowing deficit remains unclear, particularly regarding an or opharyngeal motor component. The present study examined the oropharyngeal s wallow in patients with esophageal cancer before and following transhiatal esophagectomy. Videofluoroscopic data were obtained from ten patients with esophageal cancer before and following transhiatal esophagectomy as they sw allowed 2-, 5-, and 10-cc aliquots of liquid and puree, and 0.5 and 1 tsp o f solid. Each swallow was rated on 36 parameters by three independent judge s. Swallow-related hyoid bone movement, computed from digitized segments of the videofluoroscopic data, was compared pre- and postsurgically. All pati ents showed at least mild abnormality of the oropharyngeal swallow preopera tively. Abnormalities involved all stages of swallowing in nine of the ten patients; however, the oral preparatory/oral stage was relatively more impa ired than the pharyngeal stage in the majority of patients. Postsurgically, all patients exhibited at least a mild oropharyngeal swallowing impairment . New or increased postoperative deficits involved the pharyngeal stage of swallowing, whereas oral stage abnormalities were generally improved or unc hanged following surgery. Swallow-related hyoid kinematics were highly vari able both before and following surgery. Anterior hyoid bone excursion was s ignificantly reduced postoperatively in one patient and significantly incre ased in one patient. Patients with esophageal cancer exhibit oropharyngeal dysphagia, with different profiles of abnormality before and following esop hagectomy.