Esophageal Cancer Patients Have a High Incidence of Severe Periodontitis and Preoperative Dental Care Reduces the Likelihood of Severe Pneumonia after Esophagectomy

Abstract

Background: Poor oral health is a risk factor for causing upper aerodigestive tract tumors, including esophageal cancer. Our aim was to determine the periodontitis rate in our cohort of esophageal cancer patients. We also analyzed whether preoperative dental examination and care reduces the likelihood of severe pneumonia after esophagectomy. Study Design: Between 2003 and 2014, 529 esophageal cancer patients received esophagectomy at Akita University Hospital. We studied 232 patients who had preoperative dental examinations and care (dental care group) retrospectively and assessed the severity of their periodontitis. The dental care group was compared to 297 patients who did not have preoperative dental care (control group) with respect to the incidence of severe pneumonia after esophagectomy. Results: Ninety-one patients (39.2%) in the dental care group were diagnosed with slight periodontitis and 69 (29.7%) were diagnosed with severe periodontitis. Among all the patients, 69 patients (13.0%) were diagnosed with grade 3B postoperative severe pneumonia. The dental care group had a significantly lower incidence of severe pneumonia than the control group. Moreover, multivariable logistic regression analysis revealed that anastomotic leakage, preoperative dental care, gender and %VC were correlated significantly with the occurrence of postoperative severe pneumonia. Conclusion: Preoperative dental examination and care by a dentist are essential to reduce the likelihood of postoperative severe pneumonia in esophageal cancer patients.

Preoperative oral care and effect on postoperative complications after major cancer surgery

“…The question of whether preoperative oral care by a dentist can decrease postoperative complications remains controversial, because insufficient evidence has been provided in previous studies. In existing studies, which are limited by small sample size or lack of adjustment for confounders, the odds ratios for postoperative pneumonia in patients with oesophageal cancer receiving preoperative oral care from a dentist ranged from 0·21 to 0·37.…”

“…However, it remains unclear whether preoperative oral care can reduce postoperative pneumonia and mortality. Several studies have suggested that preoperative oral care might be associated with a decrease in postoperative pneumonia after cardiac or cancer surgery, but these were limited by small sample sizes and a small number of participating institutions. The present study used a nationwide database in Japan to examine the association between preoperative oral care by dentists and postoperative pneumonia and all‐cause mortality in patients who underwent cancer surgery.…”

Do We Need to Add Postoperative Radiotherapy in Patients Undergoing Trimodality Therapy for Esophageal Squamous Cell Carcinoma with Positive Lymph Nodes Disease?

“…Lv et al [17] mentioned that there were no significant differences in survival between the preoperative chemoradiotherapy and postoperative chemoradiotherapy arm (p > 0.05). However, the postoperative therapy also provides several benefits including decision based on true pathologic stage, more accurate assessment of disease extent to allow for delineation of disease involvement, and less concern about increase in perioperative morbidity and mortality after preoperative induction [4,5,18]. Although CCRT is an important component of therapy, when used alone, it results in unacceptably high rates of relapse and poor long-term survival rates in LN-positive patients.…”

Comparison of the incidences of anastomotic leakage when PDSII or LACLON are used in esophago-gastric conduit handsewn anastomosis after esophagectomy

“…Another report based on data from 12 European countries and the United States showed that the incidence of anastomotic leakage was 16.5% after minimally invasive esophagectomy 2 . Anastomotic leakage after esophagectomy predisposes the patient to critical conditions, including mediastinitis, pleuritis and acute respiratory distress syndrome (ARDS), and increases the likelihood of reoperation and a longer ICU and hospital stay 1 , 3 . To reduce the incidence of anastomotic leakage, factors to be considered include the anastomotic method (handsewn or stapler), the type of surgical suture used for handsewn anastomosis, the technique used, time required, and blood flow to the esophagus and gastric conduit.…”