pp 1–9 | Cite as

Change in tongue pressure and the related factors after esophagectomy: a short-term, longitudinal study

  • Aya Yokoi
  • Daisuke EkuniEmail author
  • Reiko Yamanaka
  • Hironobu Hata
  • Yasuhiro Shirakawa
  • Manabu Morita
Original Article



Dysphagia is a prominent symptom after esophagectomy and may cause aspiration pneumonia. Swallowing evaluation after esophagectomy can predict and help control the incidence of postoperative pneumonia. The aim of this study was to clarify whether the change in tongue pressure was associated with any related factor and postoperative dysphagia/pneumonia in patients with esophageal cancer after esophagectomy.


Fifty-nine inpatients (41 males and 18 females; 33–77 years old) who underwent esophagectomy participated in this study. Measurement of tongue pressure and the repetitive saliva swallowing test (RSST) was performed before esophagectomy (baseline) and at 2 weeks postoperatively. The general data were collected from patients’ medical records, including sex, age, type of cancer, cancer stage, location of cancer, operative approach, history of previous chemotherapy, surgical duration, amount of bleeding during surgery, incidences of postoperative complications, intubation period, period between surgery and initiation of oral alimentation, and intensive care unit (ICU) stay, blood chemical analysis, and lifestyle.


Tongue pressure decreased significantly after esophagectomy (p = 0.011). The decrease of tongue pressure was significantly associated with length of ICU stay and preoperative tongue pressure on multiple regression analysis (p < 0.05). The decrease of tongue pressure in the RSST < 3 or postoperative pneumonia (+) group was significantly greater than in the RSST ≥ 3 (p = 0.003) or pneumonia (−) group (p = 0.021).


The decrease in tongue pressure was significantly associated with the length of ICU stay, preoperative tongue pressure, and the incidence of dysphagia and pneumonia among inpatient after esophagectomy.


Deglutition Deglutition disorders Esophageal neoplasms Esophagectomy Intensive care units 



This work was supported by Grants-in-Aid for Scientific Research (no. 15K11416) from the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan.

Compliance with ethical standards

Conflict of interest

Aya Yokoi, Daisuke Ekuni, Reiko Yamanaka, Hironobu Hata, Yasuhiro Shirakawa, and Manabu Morita declare that they have no conflict of interest.

Ethical Statement

All procedures followed were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.

Informed consent

Written, informed consent was obtained from all patients for inclusion in the study.


  1. 1.
    Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2009. Esophagus. 2009;13:110–37.CrossRefGoogle Scholar
  2. 2.
    Martin RE, Letsos P, Taves DH, et al. Oropharyngeal dysphagia in esophageal cancer before and after transhiatal esophagectomy. Dysphagia. 2001;16:23–31.CrossRefGoogle Scholar
  3. 3.
    Kaneoka A, Yang S, Inokuchi H, et al. Presentation of oropharyngeal dysphagia and rehabilitative intervention following esophagectomy: a systematic review. Dis Esophagus. 2018;31:1–11.CrossRefGoogle Scholar
  4. 4.
    Heitmiller RF, Jones B. Transient diminished airway protection after transhiatal esophagectomy. Am J Surg. 1991;162:442–6.CrossRefGoogle Scholar
  5. 5.
    Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004;78:1170–6.CrossRefGoogle Scholar
  6. 6.
    Wu N, Zhu Y, Kadel D, et al. The prognostic influence of body mass index, resting energy expenditure and fasting blood glucose on postoperative patients with esophageal cancer. BMC Gastroenterol. 2016;16:142.CrossRefGoogle Scholar
  7. 7.
    Taioli E, Schwartz RM, Lieberman-Cribbin W, et al. Quality of life after open or minimally invasive esophagectomy in patients with esophageal cancer—a systematic review. Semin Thorac Cardiovasc Surg. 2017;29:377–90.CrossRefGoogle Scholar
  8. 8.
    Yamamoto M, Yamasaki M, Sugimoto K, et al. Risk evaluation of postoperative delirium using comprehensive geriatric assessment in elderly patients with esophageal cancer. World J Surg. 2016;40:2705–12.CrossRefGoogle Scholar
  9. 9.
    Ra J, Paulson EC, Kucharczuk J, et al. Postoperative mortality after esophagectomy for cancer: development of a preoperative risk prediction model. Ann Surg Oncol. 2008;15:1577–84.CrossRefGoogle Scholar
  10. 10.
    Berry MF, Atkins BZ, Tong BC, et al. A comprehensive evaluation for aspiration after esophagectomy reduces the incidence of postoperative pneumonia. J Thorac Cardiovasc Surg. 2010;140:1266–71.CrossRefGoogle Scholar
  11. 11.
    Hasegawa Y, Sugahara K, Fukuoka T, et al. Change in tongue pressure in patients with head and neck cancer after surgical resection. Odontology. 2017;105:494–503.CrossRefGoogle Scholar
  12. 12.
    Ono T, Kumakura I, Arimoto M, et al. Influence of bite force and tongue pressure on oro-pharyngeal residue in the elderly. Gerodontology. 2007;24:143–50.CrossRefGoogle Scholar
  13. 13.
    Okumura T, Shimada Y, Watanabe T, et al. Functional outcome assessment of swallowing (FOAMS) scoring and videofluoroscopic evaluation of perioperative swallowing rehabilitation in radical esophagectomy. Surg Today. 2016;46:543–51.CrossRefGoogle Scholar
  14. 14.
    Takahashi M, Koide K, Arakawa I, et al. Association between perioral muscle pressure and masticatory performance. J Oral Rehabil. 2013;40:909–15.CrossRefGoogle Scholar
  15. 15.
    Oguchi K, Saitoh E, Baba M, et al. The Repetitive Saliva Swallowing Test (RSST) as a screening test of functional dysphagia (2) validity of RSST. Jpn J Rehabil Med. 2000;37:383–8 (in Japanese).CrossRefGoogle Scholar
  16. 16.
    Tsubosa Y, Sato H, Tachimori Y, et al. Multi-institution retrospective study of the onset frequency of postoperative pneumonia in thoracic esophageal cancer patients. Esophagus. 2014;11:126–35.CrossRefGoogle Scholar
  17. 17.
    Yokoi A, Maruyama T, Yamanaka R, et al. Relationship between acetaldehyde concentration in mouth air and tongue coating volume. J Appl Oral Sci. 2015;23:64–70.CrossRefGoogle Scholar
  18. 18.
    Henderson AR. Testing experimental data for univariate normality. Clin Chim Acta. 2006;366:112–29.CrossRefGoogle Scholar
  19. 19.
    Faul F, Erdfelder E, Lang AG, et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39:175–91.CrossRefGoogle Scholar
  20. 20.
    Pereira NC, Turrini RNT, Poveda VB. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries. Rev Esc Enferm USP. 2017;51:e03228.Google Scholar
  21. 21.
    Chang YL, Tsai YF, Wu YC, et al. Factors relating to quality of life after esophagectomy for cancer patients in Taiwan. Cancer Nurs. 2014;37:4–13.CrossRefGoogle Scholar
  22. 22.
    Luc G, Durand M, Chiche L, et al. Major post-operative complications predict long-term survival after esophagectomy in patients with adenocarcinoma of the esophagus. World J Surg. 2015;39:216–22.CrossRefGoogle Scholar
  23. 23.
    Yoshikawa H, Furuta K, Ueno M, et al. Oral symptoms including dental erosion in gastroesophageal reflux disease are associated with decreased salivary flow volume and swallowing function. J Gastroenterol. 2012;47:412–20.CrossRefGoogle Scholar
  24. 24.
    Oba S, Tohara H, Nakane A, et al. Screening tests for predicting the prognosis of oral intake in elderly patients with acute pneumonia. Odontology. 2017;105:96–102.CrossRefGoogle Scholar
  25. 25.
    Robbins J, Gangnon RE, Theis SM, et al. The effects of lingual exercise on swallowing in older adults. J Am Geriatr Soc. 2005;53:1483–9.CrossRefGoogle Scholar
  26. 26.
    Fregosi RF, Ludlow CL. Activation of upper airway muscles during breathing and swallowing. J Appl Physiol. 1985;2014(116):291–301.Google Scholar
  27. 27.
    Scholtemeijer MG, Seesing MFJ, Brenkman HJF, et al. Recurrent laryngeal nerve injury after esophagectomy for esophageal cancer: incidence, management, and impact on short- and long-term outcomes. J Thorac Dis. 2017;9:S868–78.CrossRefGoogle Scholar
  28. 28.
    Lee SY, Cheon HJ, Kim SJ, et al. Clinical predictors of aspiration after esophagectomy in esophageal cancer patients. Support Care Cancer. 2016;24:295–9.CrossRefGoogle Scholar
  29. 29.
    Huang Q, Zhong J, Yang T, et al. Impacts of anastomotic complications on the health-related quality of life after esophagectomy. J Surg Oncol. 2015;111:365–70.CrossRefGoogle Scholar
  30. 30.
    Pillon J, Gonçalves MI, De Biase NG. Changes in eating habits following total and frontolateral laryngectomy. Sao Paulo Med J. 2004;122:195–9.CrossRefGoogle Scholar
  31. 31.
    Veldhuis D, Probst G, Marek A, et al. Tumor site and disease stage as predictors of quality of life in head and neck cancer: a prospective study on patients treated with surgery or combined therapy with surgery and radiotherapy or radiochemotherapy. Eur Arch Otorhinolaryngol. 2016;273:215–24.CrossRefGoogle Scholar
  32. 32.
    Yoshida N, Watanabe M, Baba Y, et al. Risk factors for pulmonary complications after esophagectomy for esophageal cancer. Surg Today. 2014;44:526–32.CrossRefGoogle Scholar
  33. 33.
    Shiozaki A, Fujiwara H, Okamura H, et al. Risk factors for postoperative respiratory complications following esophageal cancer resection. Oncol Lett. 2012;3:907–12.Google Scholar
  34. 34.
    Yamanashi H, Shimizu Y, Higashi M, et al. Validity of maximum isometric tongue pressure as a screening test for physical frailty: cross-sectional study of Japanese community-dwelling older adults. Geriatr Gerontol Int. 2018;18:240–9.CrossRefGoogle Scholar
  35. 35.
    Utanohara Y, Hayashi R, Yoshikawa M, et al. Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23:286–90.CrossRefGoogle Scholar
  36. 36.
    Yatabe T, Kitagawa H, Yamashita K, et al. Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position. Surg Today. 2013;43:386–91.CrossRefGoogle Scholar
  37. 37.
    Liu YW, Yan FW, Tsai DL, et al. Expedite recovery from esophagectomy and reconstruction for esophageal squamous cell carcinoma after perioperative management protocol reinvention. J Thorac Dis. 2017;9:2029–37.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society and Springer 2019

Authors and Affiliations

  1. 1.Department of Preventive DentistryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  2. 2.Advanced Research Center for Oral and Craniofacial SciencesOkayama University Dental SchoolOkayamaJapan
  3. 3.Division of Hospital Dentistry, Central Clinical DepartmentOkayama University HospitalOkayamaJapan
  4. 4.Department of Dentistry and Oral SurgeryNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
  5. 5.Department of Gastroenterological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan

Personalised recommendations