Experience of Rehabilitation for Swallowing Disorders after Esophagectomy for Esophageal Cancer

Yasuhiro Tsubosa, Hiroshi Sato, Masayuki Nemoto, Makiko Ando* and Tetsuya Tsuji*

Division of Esophageal Surgery, Shizuoka Cancer Center Hospital
Division of Rehabilitation Medicine, Shizuoka Cancer Center Hospital*

We assessed the clinical experience and problem of rehabilitation in swallowing disorders following esophagectomy for thoracic esophageal cancer. Postoperative swallowing disorders were studied in 9 thoracic esophageal cancer patients who had undergone esophagectomy with lymph node dissection. Nine with actual or potential swallowing disorders underwent rehabilitation involving (1) anatomical and physiological assessment of organ-related swallowing, bolus movement, aspiration level, safe reclining angle and food safety using videofluorography; (2) repetition of direct and indirect training based on videofluorography assessment; (3) reassessment using videofluorography; and (4) repetition of (1) to (3) until dietetic self-help was possible. Five of the 9 undergoing rehabilitation had paralysis of the recurrent laryngeal nerve, including 1 with paralysis of the bilateral recurrent laryngeal nerves. Eight of the 9 undergoing rehabilitation achieved dietetic self-help without severe aspiration pneumonia. Of these 8, mean rehabilitation took 9.6 days and postoperative hospitalization 25.3 days. Mean rehabilitation for the patient with bilateral recurrent laryngeal nerve paralysis took 23 days, and postoperative hospitalization 96 days. Excluding the patient with paralysis of the bilateral recurrent laryngeal nerves, none suffered post-discharge aspiration pneumonia. It is possible that rehabilitation including complementary measures, such as appropriate reclining posture and selection of food consistencies, is effective in postoperative swallowing disorders for thoracic esophageal cancer. The patient who had paralysis of the bilateral recurrent laryngeal nerves required concomitantly greater care.

Key words
swallowing disorders, rehabilitation of swallowing, esophagectomy

Reprint requests
Yasuhiro Tsubosa Division of Esophageal Surgery, Shizuoka Cancer Center Hospital
Naga-izumi, Shizuoka, 411-8777 JAPAN

Accepted
November 30, 2004

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