The impact of prophylactic administration of a neutrophil elastase inhibitor on the postoperative course in older patients undergoing esophagectomy for esophageal cancer: a propensity score-matched analysis

Background: Sivelestat, a selective inhibitor of neutrophil elastase, has been reported to reduce acute lung injury associated with systemic inflammatory response syndrome (SIRS). However, no study has addressed the effect of prophylactic sivelestat administration on the postoperative course following an esophagectomy in older patients. Methods: In this retrospective study of patients aged >70 years, we performed a propensity score-matched analysis to compare short and long-term outcomes between patients who received early postoperative sivelestat administration (n = 42) and those who did not receive sivelestat (controls; n = 42) after a transthoracic esophagectomy for esophageal cancer (EC). Results: Patient backgrounds were well balanced between the two groups. The sivelestat group showed significantly shorter SIRS durations compared to the control group (2 vs 5 days, p = 0.001). In addition, postoperative hospital stays were shorter in the sivelestat group than in the control group (26 vs 31 days, p = 0.013). Other factors did not differ between the two groups, including the reoperation rate, ICU stay, duration of mechanical ventilation, and duration of O₂ supply. Postoperatively, the sivelestat group showed significantly lower heart rates than the control group (repeated-measures ANOVA, p = 0.0389) while respiratory rates, the SpO₂ levels, and body temperatures did not significantly differ between the two groups. Finally, long-term survival appeared to be not different between the two groups. Conclusions: Sivelestat effectively stabilized postoperative vital signs and shortened SIRS durations. Thus, prophylactic sivelestat led to shorter hospital stays among older patients with EC who underwent an esophagectomy.