To investigate the impact of swallowing training on swallowing function and quality of life in postoperative patients with esophageal cancer. We recruited 79 patients scheduled for esophageal surgery and randomly assigned them to one of three groups: Group A (conventional nursing measures), Group B (conventional nursing measures and respiratory exercises), and Group C (conventional nursing measures, respiratory exercises, and swallowing training). The EAT-10 scale and quality of life questionnaire were administered to all three groups 1 day before, 10 days after, and 30 days after surgery. The swallowing function of all three groups was evaluated 1 day before and 10 days after surgery using the standardized swallowing assessment, and the incidence of postoperative problems was calculated. The intragroup assessment showed that all groups had significantly higher the standardized swallowing assessment, EAT-10, dysphagia and eating difficulties scores (p<0.05), and significantly lower physical and role function scores 10 days after surgery (p<0.05). The intergroup assessment revealed that Group C had significantly lower EAT-10, dysphagia and eating difficulties scores (p<0.05), and significantly higher emotional functioning score than the other two groups (p<0.05). Additionally, the incidence of complications was decreased in Group B and C compared to Group A. Patients with esophageal cancer will struggle with swallowing and have a decline in quality of life after surgery. Swallowing training during the preoperative period may accelerate the recovery of swallowing function and quality of life in patients.

Xiaoqiong Wu, Shen Ling, Jian Zhang, Lin Wang, Jinkang Tu, Yuejun Lin, Yiming Wu, Tengfei Fu, Qing Yu, Jun Chen. Effect of Swallowing Training on Swallowing Function and Quality of Life of Patients after Esophageal Cancer Surgery: A Randomized Controlled Clinical Trial. Frontiers in Medical Science Research (2023) Vol. 5, Issue 6: 55-66. https://doi.org/10.25236/FMSR.2023.050610.

[1] D. J. Uhlenhopp, E. O. Then, T. Sunkara, and V. Gaduputi, “Epidemiology of esophageal cancer: update in global trends, etiology and risk factors,” Clin. J. Gastroenterol., vol. 13, no. 6, pp. 1010–1021, Dec. 2020, doi: 10.1007/s12328-020-01237-x.

[2] Cao Wei, Chen Hongda, Yu Yiwen, Li Ni, Chen Wanqing, and Ni Jing, “Changing profiles of cancer burden worldwide and in China: a secondary analysis of the global cancer statistics 2020,” Chin. Med. J. (Engl.), vol. 134, no. 07, pp. 783–791, Apr. 2021, doi: 10.1097/CM9.0000000000001474.

[3] H. Sung et al., “Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries,” CA. Cancer J. Clin., vol. 71, no. 3, pp. 209–249, May 2021, doi: 10.3322/caac.21660.

[4] C. T. Demarest and A. C. Chang, “The Landmark Series: Multimodal Therapy for Esophageal Cancer,” Ann. Surg. Oncol., vol. 28, no. 6, pp. 3375–3382, Jun. 2021, doi: 10.1245/s10434-020-09565-5.

[5] Q.-L. Xu, H. Li, Y.-J. Zhu, and G. Xu, “The treatments and postoperative complications of esophageal cancer: a review,” J. Cardiothorac. Surg., vol. 15, no. 1, p. 163, Jul. 2020, doi: 10.1186/s13019-020-01202-2.

[6] M. G. Scholtemeijer, M. F. J. Seesing, H. J. F. Brenkman, L. M. Janssen, R. van Hillegersberg, and J. P. Ruurda, “Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes,” J. Thorac. Dis., vol. 9, no. S8, pp. S868–S878, Jul. 2017, doi: 10.21037/jtd. 2017.06.92.

[7] A. Kaneoka et al., “Presentation of oropharyngeal dysphagia and rehabilitative intervention following esophagectomy: a systematic review,” Dis. Esophagus, vol. 31, no. 8, Aug. 2018, doi: 10. 1093/ dote/ doy050.

[8] R. Momosaki, “Rehabilitative management for aspiration pneumonia in elderly patients,” J. Gen. Fam. Med., vol. 18, no. 1, pp. 12–15, Mar. 2017, doi: 10.1002/jgf2.25.

[9] H. Kikuchi and H. Takeuchi, “Future Perspectives of Surgery for Esophageal Cancer,” Ann Thorac Cardiovasc Surg, p. 4, 2018.

[10] M.-L. Qiu, J.-B. Lin, X. Li, R.-G. Luo, B. Liu, and J.-W. Lin, “Current state of esophageal cancer surgery in China: a national database analysis,” BMC Cancer, vol. 19, no. 1, p. 1064, Nov. 2019, doi: 10.1186/s12885-019-6191-2.

[11] T. D. Martin et al., “Newly implemented enhanced recovery pathway positively impacts hospital length of stay,” Surg. Endosc., vol. 30, no. 9, pp. 4019–4028, Sep. 2016, doi: 10.1007/s00464-015-4714-8.

[12] S. H. Kang et al., “Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial,” Ann. Surg. Oncol., vol. 25, no. 11, pp. 3231–3238, Oct. 2018, doi: 10.1245/s10434-018-6625-0.

[13] Y. Lee, J. Yu, A. G. Doumouras, J. Li, and D. Hong, “Enhanced recovery after surgery (ERAS) versus standard recovery for elective gastric cancer surgery: A meta-analysis of randomized controlled trials,” Surg. Oncol., vol. 32, pp. 75–87, Mar. 2020, doi: 10.1016/j.suronc.2019.11.004.

[14] X. Ni, D. Jia, Y. Chen, L. Wang, and J. Suo, “Is the Enhanced Recovery After Surgery (ERAS) Program Effective and Safe in Laparoscopic Colorectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials,” J. Gastrointest. Surg., vol. 23, no. 7, pp. 1502–1512, Jul. 2019, doi: 10. 1007/ s11605-019-04170-8.

[15] S. P. Bisch et al., “Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology – A systematic review and meta-analysis.,” Gynecol. Oncol., vol. 161, no. 1, pp. 46–55, Apr. 2021, doi: 10. 1016/ j.ygyno.2020.12.035.

[16] A. Ashok et al., “The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection,” Surg. Today, vol. 50, no. 4, pp. 323–334, Apr. 2020, doi: 10. 1007/ s00595-020-01956-1.

[17] J. Inoue et al., “Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer,” Dis. Esophagus, vol. 26, no. 1, pp. 68–74, Jan. 2013, doi: 10.1111/j.1442-2050.2012.01336.x.

[18] K. H. Tukanova, S. Chidambaram, N. Guidozzi, G. B. Hanna, A. H. McGregor, and S. R. Markar, “Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis,” Ann. Surg. Oncol., vol. 29, no. 5, pp. 3148–3167, May 2022, doi: 10.1245/s10434-021-11122-7.

[19] I. Yamana et al., “Randomized Controlled Study to Evaluate the Efficacy of a Preoperative Respiratory Rehabilitation Program to Prevent Postoperative Pulmonary Complications after Esophagectomy,” Dig. Surg., vol. 32, no. 5, pp. 331–337, 2015, doi: 10.1159/000434758.

[20] P. M. Bath, H. S. Lee, and L. F. Everton, “Swallowing Therapy for Dysphagia in Acute and Subacute Stroke,” Stroke, vol. 50, no. 3, pp. e46–e47, Mar. 2019, doi: 10.1161/STROKEAHA.118.024299.

[21] J. Takatsu et al., “Clinical benefits of a swallowing intervention for esophageal cancer patients after esophagectomy,” Dis. Esophagus, vol. 34, no. 5, p. doaa094, May 2021, doi: 10.1093/dote/doaa094.

[22] S. Ozawa, K. Koyanagi, Y. Ninomiya, K. Yatabe, and T. Higuchi, “Postoperative complications of minimally invasive esophagectomy for esophageal cancer,” Ann. Gastroenterol. Surg., vol. 4, no. 2, pp. 126–134, Mar. 2020, doi: 10.1002/ags3.12315.

[23] S. Y. Lee, H.-J. Cheon, S. J. Kim, Y. M. Shim, J. I. Zo, and J. H. Hwang, “Clinical predictors of aspiration after esophagectomy in esophageal cancer patients,” Support. Care Cancer, vol. 24, no. 1, pp. 295–299, Jan. 2016, doi: 10.1007/s00520-015-2776-8.

[24] P. Koh, G. Turnbull, E. Attia, P. LeBrun, and A. G. Casson, “Functional assessment of the cervical esophagus after gastric transposition and cervical esophagogastrostomy,” Eur. J. Cardiothorac. Surg., vol. 25, no. 4, pp. 480–485, Apr. 2004, doi: 10.1016/j.ejcts.2003.12.034.

[25] M. Rubinkiewicz, J. Witowski, M. Su, P. Major, and M. Pędziwiatr, “Enhanced recovery after surgery (ERAS) programs for esophagectomy,” J. Thorac. Dis., vol. 11, no. S5, pp. S685–S691, Apr. 2019, doi: 10.21037/jtd.2018.11.56.

[26] V. Meves, A. Behrens, and J. Pohl, “Diagnostics and Early Diagnosis of Esophageal Cancer,” Visc. Med., vol. 31, no. 5, pp. 315–318, 2015, doi: 10.1159/000439473.

[27] J. A. Logemann et al., “A Randomized Study Comparing the Shaker Exercise with Traditional Therapy: A Preliminary Study,” Dysphagia, vol. 24, no. 4, pp. 403–411, Dec. 2009, doi: 10.1007/s00455-009-9217-0.

[28] J. A. Logemann, “Treatment of Oral and Pharyngeal Dysphagia,” Dysphagia, vol. 19, no. 4, pp. 803–816, Nov. 2008, doi: 10.1016/j.pmr.2008.06.003.

[29] Park Yeon-Hwan, Han Hae-Ra, Oh Seieun, and Chang HeeKyung, “Validation of the Korean Version of the Standardized Swallowing Assessment Among Nursing Home Residents.,” J. Gerontol. Nurs., vol. 40, no. 2, pp. 26–35, Feb. 2014, doi: 10.3928/00989134-20131220-08.

[30] P. C. Belafsky et al., “Validity and Reliability of the Eating Assessment Tool (EAT-10),” Ann. Otol. Rhinol. Laryngol., vol. 117, no. 12, pp. 919–924, Dec. 2008, doi: 10.1177/000348940811701210.

[31] C. Wan et al., “Validation of the simplified Chinese version of EORTC QLQ-C30 from the measurements of five types of inpatients with cancer,” Ann. Oncol., vol. 19, no. 12, pp. 2053–2060, Dec. 2008, doi: 10.1093/annonc/mdn417.

[32] H. Zhao and K. Kanda, “Translation and validation of the Standard Chinese version of the EORTC QLQ-C30,” Qual. Life Res., vol. 9, no. 2, pp. 129–137, Mar. 2000, doi: 10.1023/A:1008981520920.

[33] W.-C. Chie, C.-J. Tsai, C. Chiang, and Y.-C. Lee, “Quality of life of patients with oesophageal cancer in Taiwan: validation and application of the Taiwan Chinese (Mandarin) version of the EORTC QLQ-OES18: a brief communication,” Qual. Life Res., vol. 19, no. 8, pp. 1127–1131, Oct. 2010, doi: 10.1007/s11136-010-9675-8.

[34] Z. Dai et al., “Validation of EORTC QLQ-OES18 for Chinese patients with esophageal cancer,” Esophagus, vol. 30, no. 10, pp. 1–7, Oct. 2017, doi: 10.1093/dote/dox046.

[35] J. Cohen, Statistical power analysis for the behavioral sciences. New York: Routledge, 2013. [Online]. Available: https://doi.org/10.4324/9780203771587

[36] I. Turner Herbert M. and Bernard Robert M., “Calculating and Synthesizing Effect Sizes,” Contemp. Issues Commun. Sci. Disord., vol. 33, no. Spring, pp. 42–55, Mar. 2006, doi: 10.1044/cicsd_33_S_42.

[37] J. Khalilzadeh and A. D. A. Tasci, “Large sample size, significance level, and the effect size: Solutions to perils of using big data for academic research,” Tour. Manag., vol. 62, pp. 89–96, Oct. 2017, doi: 10.1016/j.tourman.2017.03.026.

[38] T. Okumura, Y. Shimada, T. Watanabe, N. Nakamichi, T. Nagata, and K. Tsukada, “Functional outcome assessment of swallowing (FOAMS) scoring and videofluoroscopic evaluation of perioperative swallowing rehabilitation in radical esophagectomy,” Surg. Today, vol. 46, no. 5, pp. 543–551, May 2016, doi: 10.1007/s00595-015-1203-6.

[39] M.-J. Chen et al., “Nutrition therapy in esophageal cancer—Consensus statement of the Gastroenterological Society of Taiwan,” Dis. Esophagus, vol. 31, no. 8, Aug. 2018, doi: 10. 1093/ dote/ doy016.

[40] H. KATO et al., “Videofluoroscopic Evaluation in Oropharyngeal Swallowing after Radical Esophagectomy with Lymphadenectomy for Esophageal Cancer,” Anticancer Res., vol. 27, no. 6C, p. 4249, Nov. 2007, [Online]. Available: http://ar.iiarjournals.org/content/27/6C/4249.abstract

[41] R. E. Martin, P. Letsos, D. H. Taves, R. I. Inculet, H. Johnston, and H. G. Preiksaitis, “Oropharyngeal Dysphagia in Esophageal Cancer Before and After Transhiatal Esophagectomy,” Dysphagia, vol. 16, no. 1, pp. 23–31, Jan. 2001, doi: 10.1007/s004550000044.

[42] W. G. Pearson, S. E. Langmore, L. B. Yu, and A. C. Zumwalt, “Structural Analysis of Muscles Elevating the Hyolaryngeal Complex,” Dysphagia, vol. 27, no. 4, pp. 445–451, Dec. 2012, doi: 10. 1007/ s00455-011-9392-7.

[43] J. R. Jung and J. H. Kim, “Changes in Psychological Distress and Quality of Life After Esophageal Cancer Surgery: A Prospective Study,” Asian Oncol Nurs, vol. 22, no. 1, pp. 21–28, Mar. 2022, [Online]. Available: https://doi.org/10.5388/aon.2022.22.1.21

[44] P. Lagergren et al., “Health-related quality of life among patients cured by surgery for esophageal cancer,” Cancer, vol. 110, no. 3, pp. 686–693, Aug. 2007, doi: 10.1002/cncr.22833.

[45] Q. Cheng, C. Kong, S. Chang, and A. Wei, “Effects of psychological nursing intervention on personality characteristics and quality of life of patients with esophageal cancer,” Clin. Res. Hepatol. Gastroenterol., vol. 37, no. 3, pp. 283–288, Jun. 2013, doi: 10.1016/j.clinre.2012.08.009.

[46] E. Pinto, F. Cavallin, and M. Scarpa, “Psychological support of esophageal cancer patient?” J. Thorac. Dis., vol. 11, no. S5, pp. S654–S662, Apr. 2019, doi: 10.21037/jtd. 2019.02.34.

[47] S. Däster, S. D. Soysal, L. Stoll, R. Peterli, M. von Flüe, and C. Ackermann, “Long-Term Quality of Life after Ivor Lewis Esophagectomy for Esophageal Cancer,” World J. Surg., vol. 38, no. 9, pp. 2345–2351, Sep. 2014, doi: 10.1007/s00268-014-2576-1.

[48] M. Chevallay, M. Jung, S.-H. Chon, F. R. Takeda, J. Akiyama, and S. Mönig, “Esophageal cancer surgery: review of complications and their management,” Ann. N. Y. Acad. Sci., vol. 1482, no. 1, pp. 146–162, Dec. 2020, doi: 10.1111/nyas.14492.