Association of perioperative changes in plasma and salivary substance P with cough reflex sensitivity and postoperative aspiration after esophagectomy

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Aspiration of elderly patients is caused by decreased secretion of substance P(SP) that regulates cough and swallowing reflexes. We prospectively investigated the change of perioperative plasma SP concentration in patients with esophageal cancer undergoing esophagectomy and examined the association with development of aspiration. The plasma SP concentration did not show a significant change in the perioperative period. However, decreased preoperative SP concentration had a strong association with postoperative aspiration(p=0.004), suggesting that patients with decreased preoperative plasma SP concentration(60 pg/ml or less) might carry a higher risk of development of postoperative aspiration in patients after esophagectomy.