Postoperative Swallowing Function After Minimally Invasive Esophagectomy Assessed by Videofluoroscopic Swallowing Study and Cough Test

Abstract

Background/Aim: Postoperative dysphagia is a common and clinically important complication after esophagectomy; however, perioperative changes in swallowing function and airway-protective reflexes have not been well characterized. Here, we aimed to evaluate perioperative changes in swallowing function and airway-protective reflexes after minimally invasive esophagectomy with cervical esophagogastric anastomosis. Patients and Methods: This prospective observational study included 20 patients who underwent minimally invasive esophagectomy between March 2023 and October 2024 at Hyogo Medical University. Swallowing physiology was assessed using videofluoroscopic swallowing studies performed preoperatively and before discharge. Cough reflex sensitivity was evaluated using a citric acid cough test as a complementary assessment of airway protection. Perioperative changes were analyzed descriptively using paired comparisons. Results: Among 18 patients with complete data, three postoperative parameters showed postoperative deterioration: hyoid bone movement (p=0.013), pharyngeal transit time (p=0.041), and the Penetration-Aspiration Scale score (p=0.017). The perioperative cough latency remained relatively stable (p=0.131). Postoperative swallowing parameters and cough latency did not show clear differences between patients with and without aspiration pneumonia. Conclusion: This study demonstrated measurable postoperative impairment in swallowing physiology after minimally invasive esophagectomy, whereas perioperative cough reflex sensitivity remained relatively stable. These findings underscore the clinical value of detailed swallowing assessment and may inform future postoperative swallowing rehabilitation strategies.