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01-04-2014 | Original Article

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

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

Published in: Esophagus | Issue 2/2014

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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Title: Decreased preoperative plasma substance P concentration is likely associated with postoperative silent aspiration after esophagectomy
Authors: Takushi Yasuda
Yasuhiro Nakamori
Osamu Shiraishi
Atsushi Yasuda
Ying-Feng Peng
Masayuki Shinakai
Motohiro Imano
Haruhiko Imamoto
Hitoshi Shiozaki
Publication date: 01-04-2014
Publisher: Springer Japan
Published in: Esophagus / Issue 2/2014
Print ISSN: 1612-9059
Electronic ISSN: 1612-9067
DOI: https://doi.org/10.1007/s10388-014-0415-y

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Abstract

Background

Methods

Results

Conclusion

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