Factors resulting in postoperative dysphagia following esophagectomy: a narrative review

Health-related quality of life and related factors among esophageal cancer survivors after esophagectomy in the 6-month postoperative period: A multicenter cross-sectional study in north China

Objective

Esophagectomy is a primary curable treatment and a highly challenging procedure for esophageal cancer (EC) survivors. EC survivors experience various unmet needs. This study is aimed to assess unmet needs, health-related quality of life (HRQOL), and psychological distress of postoperative EC survivors.

Methods

A multicenter cross-sectional study was conducted between December 2023 and March 2024 across 28 hospitals in northern China. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Hospital Anxiety and Depression Scale, and Supportive Care Need Survey - Short Form 34 were utilized to assess the HRQOL, anxiety, depression, and unmet needs.

Results

A total of 357 postoperative EC survivors were recruited, with a mean age of 63.42 years. Approximately 14.6% exhibited borderline anxiety, and 17.9% showed borderline depression. Unmet needs were highest in health information and patient care domains. HRQOL was lower in global health, social, and physical functions post-surgery. Fatigue, appetite loss, insomnia, and financial difficulties were common. Dysphagia, dry mouth, reflux, and choking negatively impacted HRQOL. Multivariable regression analysis indicated that anxiety and depression levels were higher, and HRQOL was lower in those one week to six months post-surgery compared to one-week post-surgery.

Conclusions

EC survivors experience significant psychological distress and reduced HRQOL up to six months post-surgery. Dysphagia and unmet needs are prevalent. Compared to immediate post-surgery, EC survivors experienced higher levels of anxiety and depression, and lower level of HRQOL in six months. Future research should focus on developing individualized care strategies to provide optimal support.

Comprehensive review of therapeutic procedures for delayed gastric conduit emptying after esophagectomy

BACKGROUND

Delayed gastric conduit emptying (DGCE) is a common functional complication after esophagectomy that significantly impairs the quality of life. Despite its clinical burden, standardized management protocols are lacking, and treatment approaches often rely on individual surgeon preference. This review aimed to evaluate the evidence on procedural interventions for established late DGCE to inform clinical decision-making.

METHODS

A systematic review was conducted across 5 databases, identifying 26 studies on DGCE interventions. Studies were assessed for quality using the Newcastle-Ottawa Scale, emphasizing the inclusion criteria that focused on procedural efficacy and outcome reporting.

RESULTS

A total of 26 studies encompassing diverse treatment modalities were included. Endoscopic approaches, such as botulinum toxin injection and balloon dilatation, have emerged as preferred first-line interventions, with success rates ranging from 50.0% to 100.0%. A hybrid approach combining both modalities demonstrated enhanced efficacy and lower recurrence, with success rates reaching 100.0%. Gastric peroral endoscopic myotomy showed promise for treatment-resistant DGCE, with experienced centers reporting success in 77.2% of refractory cases. Surgical options for gastric conduit revision were reserved for cases of DGCE with structural abnormalities, although the surgical options were associated with higher risks and complications. Significant heterogeneity in outcome definitions and reporting limited the comparability between studies.

CONCLUSION

This comprehensive evaluation provides valuable insights to assist clinicians in navigating current management strategies for DGCE. High-quality comparative studies are essential to refine treatment protocols and improve long-term patient outcomes.

Association of conduit dimensions with perioperative outcomes and long-term quality of life after esophagectomy for malignancy

Objective

The impact of conduit dimensions and location of esophagogastric anastomosis on long-term quality of life after esophagectomy remains unexplored. We investigated the association of these parameters with surgical outcomes and patient-reported quality of life at least 18 months after esophagectomy.

Methods

We identified all patients who underwent esophagectomy for cancer from 2018 to 2020 in our institution. We reviewed each patient's initial postoperative computed tomography scan measuring the gastric conduit's greatest width (centimeters), linear staple line length (centimeters), and relative location of esophagogastric anastomosis (vertebra). Quality of life was ascertained using patient-reported outcome measures. Perioperative complications, length of stay, and mortality were collected. Multivariate regressions were performed.

Results

Our study revealed that a more proximal anastomosis was linked to an increased risk of pulmonary complications, a lower recurrence rate, and greater long-term insomnia. Increased maximum intrathoracic conduit width was significantly associated with trouble enjoying meals and reflux long term after esophagectomy. A longer conduit stapled line correlated with fewer issues related to insomnia, improved appetite, less dysphagia, and significantly enhanced "social," "role," and "physical'" aspects of the patient's long-term quality of life.

Conclusions

The dimensions of the gastric conduit and the height of the anastomosis may be independently associated with outcomes and long-term quality of life after esophagectomy for cancer.

Dysphagia After Esophageal Replacement and Its Treatment

Dysphagia occurs temporarily or permanently following esophageal replacement in at least half of the cases. Swallowing disorder, in addition to severe decline in the quality of life, can lead to a deterioration of the general condition, which may lead to death if left untreated. For this reason, their early detection and treatment are a matter of importance. Between 1993 and 2012, 540 esophageal resections were performed due to malignant tumors at the Department of Surgery, Medical Center of the University of Pécs. Stomach was used for replacement in 445 cases, colon in 38 cases, and jejunum in 57 cases. The anastomosis with a stomach replacement was located to the neck in 275 cases and to the thorax in 170 cases. The colon was pulled up to the neck in each case. There were 29 cases of free jejunal replacements located to the neck and 28 cases with a Roux loop reconstruction located to the thorax. Based on the literature data and own experience, the following were found to be the causes of dysphagia in the order of frequency: anastomotic stenosis, conduit obstruction, peptic and ischemic stricture, foreign body, local recurrence, functional causes, new malignant tumor in the esophageal remnant, and malignant tumor in the organ used for replacement. Causes may overlap each other, and their treatment may be conservative or surgical. The causes of many dysphagic complications might be prevented by improving the anastomosis technique, by better preservation the blood supply of the substitute organ, by consistently applying a functional approach, and by regular follow-up.