545. THE NATURE, SEVERITY AND IMPACT OF CURATIVE OESOPHAGEAL RESECTION FOR OESOPHAGEAL CANCER ON SWALLOWING THROUGHOUT SURVIVORSHIP: PRELIMINARY FINDINGS. (24th September 2022)

• Record Type: Journal Article
• Authors: Gillman, Anna; Reynolds, John V; Hayes, Michelle; Walshe, Margaret; Regan, Julie
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.545
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Survivors of curative oesophageal resection for oesophageal cancer present with oropharyngeal and oesophageal dysphagia for many years following surgery. Few studies have explored the presentation of oropharyngeal dysphagia throughout survivorship or its impact on swallow-related quality of life (QoL). This prospective observational study investigated 1) the nature, severity and QoL impact of transhiatal, 2 stage and 3 stage surgeries on swallowing at least 12 months post-operatively, and 2) relevant surgical and clinical associations. Seventeen adults were recruited from a national centre for oesophageal cancer, including 14 males, 3 females (mean age = 62.59+/-10.44 years), who were a mean of 35.12 months (+/- 23.03) post curative oesophageal resection. Participants were assessed using videofluoroscopy (rated via MBS Impairment Profile), the EORTC-QLQ-OES-18 and Reflux Swallow Index (RSI) between November 2021 and March 2022. The Functional Oral Intake Scale (FOIS) was used to evaluate oral intake status. Bivariate analysis was conducted to investigate associations between the surgical approach, time since surgery, presence of dysphagia, altered diet, reflux, and QOL. Participants presented with reduced laryngeal elevation (100%), delayed pharyngeal swallow initiation (94.2%), reduced hyoid movement (88.2%), reduced UES opening (70.7%) and oesophageal retention (89%). Mean MBS Imp Total Oral and Pharyngeal Scores were 5.41+/-2.58 and 7.53+/-2.6 respectively. 3 participants penetrated food/fluids (PAS mean 1.24 +/-.56). Mean FOIS, RSI and EORTC scores were 6.53+/-.514, 8.47+/-10.17 and 37.59+/-9.17 respectively. Surgical approach was associated with altered diet (FOIS) (p = 0.039). Time since surgery was associated with pharyngeal dysphagia (Total Pharyngeal Score (p = 0.023)), QOL was associated with altered diet (p= 0.038), RSI (p <0.001) and reduced anterior hyoid excursion (p= 0.046). This preliminary study found that 1) all participants presented with an element of oropharyngeal dysphagia and 2) there are significant associations between surgical elements and oropharyngeal dysphagia, and between quality of life and altered diet, reflux, and hyoid movement. Further research and improved clinical practices are therefore required to minimise the severity of dysphagia experienced, to manage this chronic dysphagia throughout survivorship, and to ultimately reduce the impact it has on survivors.