Swallowing biomechanics and upper esophageal sphincter pressure remain altered after esophagectomy for thoracic esophageal cancer

Abstract Postoperative dysphagia is common after esophagectomy for thoracic esophageal cancer, but its long-term mechanisms remain poorly understood. This prospective study evaluated longitudinal changes in swallowing function and pressure dynamics through 6 months postoperatively. Thirteen patients who underwent subtotal esophagectomy with gastric conduit reconstruction were assessed preoperatively and at 1, 3, and 6 months postoperatively using a videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), and the Eating Assessment Tool-10 (EAT-10). High-resolution manometry (HRM) was performed preoperatively and at 6 months postoperatively. EAT-10 scores increased significantly at 1 and 3 months, while the median score remained above baseline at 6 months without reaching statistical significance. VFSS demonstrated significant reductions in laryngeal elevation distance (LED) and hyoid forward displacement at 6 months. HRM revealed a significant increase in upper esophageal sphincter integrated relaxation pressure (UES-IRP), whereas meso-hypopharyngeal contractile integral (MHPCI) was unchanged. LED was negatively correlated with UES-IRP. Additional analyses showed no significant relationships between EAT-10 and LED or UES-IRP. Exploratory regression analyses suggested an association between anastomotic stricture and higher 6 months EAT-10 scores. These findings indicate that objective biomechanical abnormalities may persist despite an unclear relationship with patient-reported symptoms, supporting multimodal assessment using subjective and objective measures.