The Effect of Compensatory Strategies in Reducing to Postoperative Airway Invasion, and Pharyngeal Residue in Patients Undergoing Esophagectomy for Esophageal Cancer

Few studies have reported the effects of dysphagia management after esophagectomy in esophageal cancer. We aimed to investigate the impact of liquid modification and chin-tuck posture (head flexion) on reducing airway invasion and pharyngeal residue after esophagectomy. We included patients who underwent esophagectomy between June 2017 and January 2020. A videofluoroscopic swallowing study (VFSS) was conducted on 5 ml liquid boluses with four viscosities: thin, mildly thickened, moderately thickened, and extremely thickened, all administered in a neutral head position. Trials with thin and moderately thickened liquid were repeated with head flexion. The penetration-aspiration scale (PAS) scores and residue grades were compared across viscosities and head positions. Thirty-three patients met the inclusion criteria (mean age 65.3 ± 9.0 years). Moderately and extremely thickened liquids resulted in less frequent penetration or aspiration compared to thin liquids, while mildly thickened liquids showed no significant difference in airway protection. Residue grades did not differ significantly across the viscosities tested. Head flexion did not affect the occurrence of aspiration or residue grades compared with the neutral head position for thin and moderately thickened liquids. Penetration on thin liquid was less frequent in head flexion than in the neutral position. Liquid modification improved swallowing safety by reducing penetration and aspiration without affecting pharyngeal clearance. While the chin-tuck posture did not significantly reduce aspiration, its potential to lessen penetration suggests a role in airway protection that warrants further study. These findings warrant validation in larger studies.