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Perioperative Decrease in Tongue Pressure is an Intervenable Predictor of Aspiration After Esophagectomy

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Abstract

Despite the increasing use of minimally invasive esophagectomies, aspiration pneumonia remains the most serious complication. This study clarified the association between perioperative tongue pressure and postoperative aspiration after thoracoscopic-laparoscopic esophagectomy in patients with esophageal cancer. This retrospective, single-center, observational study evaluated data of 216 patients scheduled for thoracoscopic-laparoscopic esophagectomy. Tongue pressure was measured before the procedure and on postoperative day 6; perioperative changes were assessed. Patients were divided into non-aspiration and aspiration groups according to penetration–aspiration scale scores. Hierarchical and stratified logistic regression analyses were performed to identify factors associated with aspiration. Receiver operating characteristic curves were used to assess the cut-off value of perioperative changes in tongue pressure for aspiration. Perioperative changes in tongue pressure (odds ratio 0.92; 95% confidence interval 0.88–0.96, P < 0.001), age (odds ratio 1.07; 95% confidence interval 1.01–1.13, P = 0.013), and postoperative recurrent laryngeal nerve palsy (odds ratio 3.04; 95% confidence interval 1.15–8.03, P = 0.025) were significantly associated with aspiration. The cut-off value of perioperative changes in tongue pressure for postoperative aspiration was − 6.58%. In addition, decreases in tongue pressure were associated with aspiration regardless of recurrent laryngeal nerve palsy and age. The perioperative decrease in tongue pressure, higher age, and postoperative recurrent laryngeal nerve palsy were significant factors strongly associated with aspiration in the acute phase post-esophagectomy. Decreased tongue pressure is the only intervenable predictor of aspiration. Rehabilitation for preventing decreases in tongue pressure may reduce the risk of aspiration.

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Acknowledgements

The authors thank the members of the Department of Musculoskeletal Oncology and Rehabilitation and Esophageal Surgery, National Cancer Center. This research would not have been possible without their leadership and cooperation.

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Author notes

  1. Kazuhiro Kojima and Takuya Fukushima have contributed equally.

Authors and Affiliations

  1. Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan

    Kazuhiro Kojima, Takuya Fukushima & Aiko Matsuoka

  2. Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan

    Daisuke Kurita, Koshiro Ishiyama, Junya Oguma & Hiroyuki Daiko

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  1. Kazuhiro Kojima
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  2. Takuya Fukushima
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  7. Hiroyuki Daiko
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by KK, DK, and AM. The first draft of the manuscript was written by KK, TF, and DK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hiroyuki Daiko.

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Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all the patients prior to their inclusion in the study. Ethical approval was obtained from the Institutional Review Board of the NCCH (2017-061).

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Kojima, K., Fukushima, T., Kurita, D. et al. Perioperative Decrease in Tongue Pressure is an Intervenable Predictor of Aspiration After Esophagectomy. Dysphagia 38, 1147–1155 (2023). https://doi.org/10.1007/s00455-022-10541-2

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