Maximum pharyngeal constriction area: an independent predictor of sarcopenic dysphagia after esophageal cancer surgery

The exact mechanism of sarcopenic dysphagia following esophagectomy, which is associated with reduced pharyngeal contraction, remains unclear. This study measured the maximum pharyngeal constriction area normalized (MPCAn) as a potential indicator of post-esophagectomy sarcopenic dysphagia. Videofluoroscopic examination of swallowing study was conducted in 134 patients with suspected dysphagia following esophagectomy, defined as a score of ≥3 in the 8-point penetration-aspiration scale. The area under the receiver operating characteristic curve of MPCAn was applied to detect dysphagia in comparison with duration and distance of hyoid bone elevation and upper esophageal sphincter opening width. Cutoff MPCAn values were used to compare patient characteristics, including body composition and physical function. Multivariate analysis was employed to evaluate the association of MPCAn with postoperative pneumonia and recurrent laryngeal nerve paralysis (RLNP). MPCAn was an important predictor of dysphagia, compared to the three videofluoroscopic examination of swallowing study parameters (0.874 vs. 0.784, P = 0.006). MPCAn was an independent risk factor for dysphagia at a cutoff value of 14. The patients with a larger MPCAn (N = 58) had significantly lower body mass index and worse timed Up and Go test results than those with a smaller MPCAn (N = 76) (19.76 vs. 21.56 kg/m2, P = 0.021 and 7.25 vs. 5.85 s; P = 0.014, respectively). MPCAn was significantly associated with late-onset pneumonia (odds ratio 2.58, 95% 1.03-6.46; P = 0.044) and was the only significant risk factor for dysphagia in those without RLNP (odds ratio 35.90, 95% confidence interval 6.20-205; P < 0.001). MPCAn was a useful predictor of post-esophagectomy sarcopenic dysphagia, especially in patients without RLNP, and was significantly associated with late-onset pneumonia.