Association of preoperative sarcopenia with postoperative dysphagia in patients with thoracic esophageal cancer

2020 ◽  
Author(s):  
Shuhei Mayanagi ◽  
Aiko Ishikawa ◽  
Kazuaki Matsui ◽  
Satoru Matsuda ◽  
Tomoyuki Irino ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Oral Intake ◽  
Psoas Muscle ◽  
Postoperative Dysphagia ◽  
Thoracic Esophageal Cancer ◽  
Swallowing Function ◽  
Cross Sectional ◽  
Swallowing Rehabilitation ◽  
Significant Difference

Summary Background The purpose of the current study was to clarify the relationship between clinical features of dysphagia after esophagectomy and preoperative sarcopenia. Methods A total of 187 cases were included in the current study. The psoas cross-sectional area on pre-treatment computed tomography was measured in thoracic esophageal cancer patients who underwent curative resection. The psoas muscle index (PMI) cut-off levels for sarcopenia were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. Swallowing function was evaluated using videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES) at postoperative days 7–15, and classified according to the food intake level scale (FILS). Perioperative swallowing rehabilitation was performed in all cases. Results In the 187 included patients, the median PMI was 5.42 cm2/m2 for men and 3.43 cm2/m2 for women, and 133 cases (71%) met the sarcopenia criteria. The FILS <4 (no oral intake) was 15% in the non-sarcopenia group, and 38% in the sarcopenia group (P = 0.003). There was no significant difference in the incidence of postoperative complications, including pneumonia and re-admission due to pneumonia, between the two groups. Preoperative sarcopenia and recurrent laryngeal nerve palsy were be independent risk factors for postoperative dysphagia. Conclusions Sarcopenic patients with esophageal cancer develop postoperative dysphagia more often than non-sarcopenic patients. Prehabilitation and nutritional support for patients with preoperative sarcopenia could play an important role to mitigate postoperative dysphagia.

Swallowing Function-preserving Surgery for Thoracic Esophageal Cancer

2008 ◽  
Vol 59 (2) ◽  
pp. 213-213
Author(s):  
M. Yano ◽  
K. Takachi ◽  
K. Kishi ◽  
I. Miyashiro ◽  
S. Noura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Thoracic Esophageal Cancer ◽  
Swallowing Function

Weak psoas and spine extensors potentially predispose to hip fracture

2020 ◽  
pp. 112070002090433
Author(s):  
Keong-Hwan Kim ◽  
Jun Hee Lee ◽  
Eic Ju Lim
Keyword(s):  
Hip Fracture ◽  
Lumbar Vertebra ◽  
Psoas Muscle ◽  
Hounsfield Unit ◽  
The Body ◽  
Whole Body ◽  
Cross Sectional ◽  
Fracture Group ◽  
Extensor Muscles ◽  
Significant Difference

Introduction: We performed a computed tomography analysis of muscle composition characteristics in hip fracture patients and non-hip fracture controls. Methods: In total, 43 patients (9 men, 34 women) were included in the hip fracture group, matched 1 to 1 with non-hip fracture controls. Muscle cross-sectional areas were measured in axial CT scan at the body level of the 4th lumbar vertebra (L4), intervertebral disc level between the 5th lumbar vertebra and the 1st sacral vertebra (L5-S1) and just below level of the lesser trochanter (LT). Attenuation was also evaluated through the mean Hounsfield unit (HU) in these areas. Results: The cross-sectional area per weight (CSA/Wt, mm2/kg) of psoas muscle and extensor muscles of the spine showed a significant difference between the 2 groups at both L4 (9.7 vs. 12.4, p  < 0.001 and 26.3 vs. 29.2, p  = 0.025) and L5-S1 (9.6 vs. 11.5, p  = 0.001 and 8.8 vs. 10.3, p  = 0.041) levels. In addition, the HU of these muscles differed significantly between the 2 groups at both L4 (33.3 vs. 47.6, p  < 0.001 and 13.7 vs. 30.2, p  < 0.001) and L5-S1 (39.7 vs. 52.6, p  < 0.001 and 3.8 vs. 15.1, p  = 0.012) levels. There was no difference in abdominal wall, gluteal, or thigh compartment musculature between the groups. Conclusions: Poorer quantity and quality of psoas muscle and extensor muscles of the spine rather than whole body muscles may contribute to falls and were characteristic features of the hip fracture patients in this series. These findings should be considered when recommending a preventive exercise and rehabilitation protocol.

Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy

2020 ◽  
Author(s):  
Jun Takatsu ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Masahiro Yoshida ◽  
Masahiko Yamamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Enhanced Recovery ◽  
Intervention Group ◽  
Oral Intake ◽  
Control Group ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Swallowing Function ◽  
Nerve Paralysis ◽  
Postoperative Stay

Summary Dysphagia after esophagectomy is the main cause of a prolonged postoperative stay. The present study investigated the effects of a swallowing intervention led by a speech–language–hearing therapist (SLHT) on postoperative dysphagia. We enrolled 276 consecutive esophageal cancer patients who underwent esophagectomy and cervical esophagogastric anastomosis between July 2015 and December 2018; 109 received standard care (control group) and 167 were treated by a swallowing intervention (intervention group). In the intervention group, swallowing function screening and rehabilitation based on each patient’s dysfunction were led by SLHT. The start of oral intake, length of oral intake rehabilitation, and length of the postoperative stay were compared in the two groups. The patient’s subgroups in the 276 patients were examined to clarify the more effectiveness of the intervention. The start of oral intake was significantly earlier in the intervention group (POD: 11 vs. 8 days; P = 0.009). In the subgroup analysis, the length of the postoperative stay was also significantly shortened by the swallowing intervention in patients without complications (POD: 18 vs. 14 days; P = 0.001) and with recurrent laryngeal nerve paralysis (RLNP) (POD: 30 vs. 21.5 days; P = 0.003). A multivariate regression analysis identified the swallowing intervention as a significant independent factor for the earlier start of oral intake and a shorter postoperative stay in patients without complications and with RLNP. Our proposed swallowing intervention is beneficial for the earlier start of oral intake and discharge after esophagectomy, particularly in patients without complications and with RLNP. This program may contribute to enhanced recovery after surgery.

scholarly journals Significance of Tumor Length as Prognostic Factor for Esophageal Cancer

2013 ◽  
Vol 98 (3) ◽  
pp. 234-240 ◽  
Author(s):  
Arife Zeybek ◽  
Abdullah Erdoğan ◽  
Kemal Hakan Gülkesen ◽  
Makbule Ergin ◽  
Alpay Sarper ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Specific Treatment ◽  
Disease Free Survival ◽  
Curative Surgery ◽  
Thoracic Esophageal Cancer ◽  
Clinicopathologic Characteristics ◽  
Term Survival ◽  
Tumor Length ◽  
Significant Difference

Abstract Our study indicated the relationship between tumor length and clinicopathologic characteristics as well as long-term survival in esophageal cancer. A total of 116 patients who underwent curative surgery for thoracic esophageal cancer with standard lymphadenectomy in 2 fields between 2000 and 2010 were included in the study. The medical records of these patients were retrospectively reviewed. The patients with tumor length ≥3 cm had a highly significant difference in the involvement of adventitia and lymph node stations. The patients with tumor length ≤3 cm had significantly lower rates of involvement of the adventitia and lymph node stations. Tumor length could have a significant impact on both the overall survival and disease-free survival of patients with resected esophageal carcinomas and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.

RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 35-35
Author(s):  
Hong Yang
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Nodal Metastasis ◽  
Laryngeal Nerve ◽  
Intraoperative Ultrasonography ◽  
Nodal Metastases ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Effect of Swallowing Rehabilitation Protocol on Swallowing Function in Patients with Esophageal Atresia and/or Tracheoesophageal Fistula

2017 ◽  
Vol 27 (06) ◽  
pp. 526-532 ◽  
Author(s):  
Selen Serel Arslan ◽  
Numan Demir ◽  
Sule Yalcın ◽  
Ayşe Karaduman ◽  
Ibrahim Karnak ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Tracheoesophageal Fistula ◽  
Oral Intake ◽  
Control Group ◽  
Study Group ◽  
Start Time ◽  
Swallowing Function ◽  
Rehabilitation Protocol ◽  
Swallowing Rehabilitation ◽  
Pharyngeal Swallowing

Aim The aim of this study was to evaluate the results of Swallowing Rehabilitation Protocol (SRP) on swallowing function (SF) of esophageal atresia and tracheoesophageal fistula (EA-TEF) patients with pharyngeal swallowing disorder. Materials and Methods In this study, 24 children with EA-TEF who had deglutitive and respiratory problems were grouped into either study (n = 12) or control group (n = 12) by basic randomization. Study group received the SRP including neuromuscular electrical stimulation, thermal tactile stimulation, and hyolaryngeal mobilization. The control group received nonnutritive stimulations. SF was evaluated with 3 mL liquid and pudding barium by videofluoroscopic swallowing study (VFSS) before and after 20 sessions of interventions. Results No statistical differences were found between groups in terms of descriptive characteristics including age, sex, weight, height, type of atresia, repair type, repair time, and start time of oral intake (p > 0.05). There were no statistical differences between groups in term of swallowing parameters (p > 0.05), except reflux (p = 0.004) according to VFSS findings. After 20 sessions of interventions, the study group showed improvement in penetration–aspiration scale scores, oral phase dysfunction, delay in swallowing reflex, and residue in valleculae and pyriform sinuses after pudding swallow. The control group showed improvement only in oral phase dysfunction. Conclusion SRP can be recommended to improve SF in patients with EA/TEF who have pharyngeal swallowing disorders.

scholarly journals HbA1c and Aortic Calcification Index as Noninvasive Predictors of Pre-Existing Histopathological Damages in Living Donor Kidney Transplantation

2020 ◽  
Vol 9 (10) ◽  
pp. 3266
Author(s):  
Kosuke Tanaka ◽  
Shigeyoshi Yamanaga ◽  
Yuji Hidaka ◽  
Sho Nishida ◽  
Kohei Kinoshita ◽  
...  
Keyword(s):  
Interstitial Fibrosis ◽  
Psoas Muscle ◽  
Living Donors ◽  
Aortic Calcification ◽  
Related Factors ◽  
Tubular Atrophy ◽  
Cross Sectional ◽  
Living Kidney Donors ◽  
Significant Difference ◽  
And Control

We previously reported that allografts from living donors may have pre-existing histopathological damages, defined as the combination of interstitial fibrosis (ci), tubular atrophy (ct), and arteriolar hyalinosis (ah) scores of ≧1, according to the Banff classification. We examined preoperative characteristics to identify whether the degree of these damages was related to metabolic syndrome-related factors of donors. We conducted a single-center cross-sectional analysis including 183 living kidney donors. Donors were divided into two groups: chronic change (ci + ct ≧ 1 ∩ ah ≧ 1, n = 27) and control (n = 156). Preoperative characteristics, including age, sex, blood pressure, hemoglobin A1c (HbA1c), aortic calcification index (ACI), and psoas muscle index (PMI), were analyzed. Comparing the groups, the baseline estimated glomerular filtration rate was not significantly different; however, we observed a significant difference for ACI (p = 0.009). HbA1c (p = 0.016) and ACI (p = 0.006) were independent risk factors to predict pre-existing histopathological damages, whereas PMI was not. HbA1c correlated with ct scores (p = 0.035), and ACI correlated with ci (p = 0.005), ct (p = 0.021), and ah (p = 0.017). HbA1c and ACI may serve as preoperative markers for identifying pre-existing damages on the kidneys of living donors.

scholarly journals The Esophageal Adenocarcinoma Epidemic Has Reached Hungary: A Multicenter, Cross-Sectional Study

2020 ◽  
Vol 10 ◽  
Author(s):  
Benedek Tinusz ◽  
László Botond Szapáry ◽  
Bence Paládi ◽  
András Papp ◽  
Barna Bogner ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cell Cancer ◽  
Cross Sectional Study ◽  
Linear Regression Models ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Histological Types ◽  
Relative Incidence ◽  
Significant Difference

BackgroundThe epidemiology of esophageal cancer has changed dramatically over the past 4 decades in many Western populations. We aimed to understand the Hungarian epidemiologic trends of esophageal squamous cell cancer (SCC) and adenocarcinoma (AC).MethodsWe performed a cross-sectional study using data from esophageal cancer patients diagnosed between 1992 and 2018 at eight tertiary referral centers in four major cities of Hungary. We retrospectively identified cases in the electronic databases of each center and collected data on gender, age at diagnosis, year of diagnosis, specialty of the origin center, histological type, and localization of the tumor. Patients were grouped based on the two main histological types: AC or SCC. For statistical analysis, we used linear regression models, chi-square tests, and independent sample t tests.ResultsWe extracted data on 3,283 patients with esophageal cancer. Of these, 2,632 were diagnosed with either of the two main histological types; 737 had AC and 1,895 SCC. There was no significant difference in the gender ratio of the patients between AC and SCC (80.1 vs 81.8% males, respectively; p = 0.261). The relative incidence of AC increased over the years (p &lt; 0.001, b = 1.19 CI: 0.84–1.54). AC patients were older at diagnosis than SCC patients (64.37 ± 11.59 vs 60.30 ± 10.07 years, p &lt; 0.001). The age of patients at the diagnosis of primary esophageal cancer increased over time (p &lt; 0.001, R = 0.119).ConclusionsThe rapid increase in the relative incidence of AC and simultaneous decrease of the relative incidence of SCC suggest that this well-established Western phenomenon is also present in Hungary.

PS02.246: SURGICAL OUTCOMES OF SURGICAL T4B THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 192-192
Author(s):  
Norihisa Uemura ◽  
Tetsuya Abe ◽  
Eiji Higaki ◽  
Takahiro Hosoi ◽  
Byonggu An
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factor ◽  
Surgical Outcomes ◽  
Curative Resection ◽  
Conflicts Of Interest ◽  
Post Treatment ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background Patients with surgical T4b (sT4b) thoracic esophageal cancer undergo exploratory thoracotomy or non-curative resection. However, in some cases, it is difficult to decide whether to perform exploratory thoracotomy without resection, or perform non-curative resection to the extent possible. The purpose of this retrospective study was to analyze surgical outcomes of sT4b thoracic esophageal cancer to clarify the optimal treatment strategy. Methods A total of 12 patients with sT4b thoracic esophageal cancer underwent exploratory thoracotomy (n = 7) or non-curative resection (n = 5) between January 2011 and December 2015. Of the seven patients who underwent exploratory thoracotomy, two underwent bypass surgery. In the five patients who underwent non-curative resection, gastric reconstruction was performed. Clinical data from these 12 patients were analyzed retrospectively. Results Compared to the seven patients who underwent exploratory thoracotomy (Ex group), the five patients who underwent non-curative resection (NC group) had a significantly longer period until the start of post-treatment (median, 23/57 (Ex/NC) days; P = 0.0027). No significant difference was observed in the postoperative survival period between the two groups (Median survival time (MST), 9/12 (Ex/NC) months; P = 0.55). In the prognostic factor analysis, patients with progressive disease (PD) responsiveness to preoperative treatment had a significantly poorer prognosis (MST, 13.5/5.5 (partial response-stable disease/PD) months; P = 0.01). On the other hand, patients with cStage 3 disease and who received postoperative chemoradiotherapy had a relatively good prognosis (cStage 3/4; MST 12.5/5.5 month, P = 0.09, postoperative chemoradiotherapy received/not received; MST 13/5 month, P = 0.11). The period until the start of post-treatment was not a prognostic factor. Conclusion Responsiveness to preoperative treatment was found to be a prognostic factor in patients with sT4b thoracic esophageal cancer. Thus, if patients show a poor response to preoperative treatment, R0 resection should be performed without exploratory thoracotomy. On the contrary, for patients with a good response to preoperative treatment, administration of post-operative chemoradiotherapy should be considered, while maintaining performance status without causing serious secondary injury. Disclosure All authors have declared no conflicts of interest.

scholarly journals Efficacy of Myofunctional Therapy Associated with Voice Therapy in the Rehabilitation of Neurogenic Oropharyngeal Dysphagia: a pilot study

2017 ◽  
Vol 22 (03) ◽  
pp. 225-230 ◽  
Author(s):  
Bruno Fraga ◽  
Sheila Almeida ◽  
Márcia Santana ◽  
Mauriceia Cassol
Keyword(s):  
Pilot Study ◽  
Oropharyngeal Dysphagia ◽  
Oral Intake ◽  
Control Group ◽  
Stroke Patients ◽  
Swallowing Rehabilitation ◽  
Significant Difference ◽  
Vocal Exercises ◽  
Experimental Group ◽  
Post Therapy

Introduction Dysphagia causes changes in the laryngeal and stomatognathic structures; however, the use of vocal exercises is poorly described. Objective To verify whether the therapy consisting of myofunctional exercises associated with vocal exercises is more effective in rehabilitating deglutition in stroke patients. Methods This is a pilot study made up of two distinct groups: a control group, which performed only myofunctional exercises, and an experimental group, which performed myofunctional and vocal exercises. The assessment used for oral intake was the functional oral intake scale (FOIS). Results The FOIS levels reveal that the pre-therapy median of the experimental group was 4, and increased to 7 after therapy, while in the control group the values were 5 and 6 respectively. Thus, the experimental group had a statistically significant difference between the pre- and post-therapy assessments (p = 0.039), which indicates that the combination of myofunctional and vocal exercises was more effective in improving the oral intake levels than the myofunctional exercises alone (p = 0.059). On the other hand, the control group also improved, albeit at a lower rate compared with the experimental group; hence, there was no statistically significant difference between the groups post-therapy (p = 0.126). Conclusion This pilot study showed indications that using vocal exercises in swallowing rehabilitation in stroke patients was able to yield a greater increase in the oral intake levels. Nevertheless, further controlled blind clinical trials with larger samples are required to confirm such evidence, as this study points to the feasibility of conducting this type of research.

Sign in / Sign up

Export Citation Format

Share Document