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Decreased preoperative plasma substance P concentration is likely associated with postoperative silent aspiration after esophagectomy

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Abstract

Background

Postoperative pneumonia is the most common complication after esophagectomy and is closely associated with swallowing dysfunction and silent aspiration. Silent aspiration in the elderly is associated with decreased secretion of substance P (SP), which controls the swallowing and cough reflexes. The majority of patients with esophageal cancer are elderly. We hypothesized that surgical stress would decrease SP secretion, thereby increasing the risk of postoperative aspiration after esophagectomy, and prospectively investigated.

Methods

Thirty patients with esophageal cancer scheduled to undergo esophagectomy were enrolled in the study. Plasma and salivary SP concentrations and cough reflex sensitivity were measured before surgery and on postoperative days 2 and 7 to examine the association with postoperative aspiration.

Results

Postoperative silent aspiration was observed in 6 patients, 4 of whom developed pneumonia. Plasma SP concentration did not change significantly during the perioperative period. Salivary SP concentration and cough reflex sensitivity could not be measured in nearly one-third of patients because of postoperative dry mouth and unwillingness of patients to undergo measurement, respectively; thus, these perioperative changes could not be assessed. Preoperative plasma and salivary SP concentrations had a significant association with postoperative aspiration on univariate analysis and multivariate logistic regression analysis using variables selected by stepwise forward selection identified preoperative plasma SP concentration as the only significant risk factor for postoperative aspiration (p = 0.023).

Conclusion

Definitive results supporting our hypothesis could not be obtained. However, multivariate analysis suggested that decreased preoperative plasma SP concentration is likely associated with postoperative silent aspiration after esophagectomy.

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Acknowledgments

This work was supported as a Grant-in-Aid for Scientific Research (C) by Japan Society for Promotion of Science (JSPS) KAKENHI Grant Number 21591716. The authors thank lecturer Yasutaka Chiba from the division of Biostatics, Clinical Research Center, Kinki University Faculty of Medicine for advice regarding statistical analysis.

Ethical Statement

This study was approved by the Institutional Review Board of Ethics Committee and was conducted in accordance with Helsinki Declaration of 1975, as revised in 2000 and 2008, and informed consent was obtained from all patients. Those were involved in the prerequisites for publication in the certification form as No. 5 item and all authors certified and put their own signatures on the form.

Conflict of interest

There are no financial or other relations that could lead to a conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Takushi Yasuda, Yasuhiro Nakamori, Osamu Shiraishi, Atsushi Yasuda, Ying-Feng Peng, Masayuki Shinakai, Motohiro Imano, Haruhiko Imamoto & Hitoshi Shiozaki

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  1. Takushi Yasuda
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  2. Yasuhiro Nakamori
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  3. Osamu Shiraishi
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  4. Atsushi Yasuda
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  7. Motohiro Imano
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  9. Hitoshi Shiozaki
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Correspondence to Takushi Yasuda.

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Yasuda, T., Nakamori, Y., Shiraishi, O. et al. Decreased preoperative plasma substance P concentration is likely associated with postoperative silent aspiration after esophagectomy. Esophagus 11, 99–107 (2014). https://doi.org/10.1007/s10388-014-0415-y

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  • DOI: https://doi.org/10.1007/s10388-014-0415-y

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