Advertisement

Pre-operative dental brushing can reduce the risk of postoperative pneumonia in esophageal cancer patients

Published:December 11, 2009DOI:https://doi.org/10.1016/j.surg.2009.10.048

      Background

      The presence of pathogens in dental plaque is a risk factor associated with postoperative pneumonia in esophageal cancer patients. The effectiveness of pre-operative dental brushing to decrease the risk of postoperative pneumonia in esophageal cancer patients was evaluated prospectively.

      Methods

      A total of 86 thoracic esophageal cancer patients who underwent an esophagectomy were investigated. Patients were divided into 2 groups: the control group (41 patients) and the pre-operative dental brushing group (45 patients). The patients in the brushing group were assigned to brush their teeth 5 times a day. After the operation, the frequency of postoperative pneumonia and need for tracheostomy for pulmonary treatment was calculated.

      Results

      Postoperative pneumonia was decreased markedly from 32% to 9% (P = .013), and the frequency of postoperative pneumonia requiring tracheostomy decreased from 12% to 0% in the dental brushing group, respectively. Limiting the patients who had positive pathogenic bacteria in their dental plaque on their admission, the frequency of postoperative pneumonia was decreased from 71% (5 of 7 patients) in the control group to 17% (2 of 12 patients) in the dental brushing group (P = .045).

      Conclusion

      Frequent pre-operative dental brushing is performed easily and seems to prevent postoperative pneumonia in esophageal cancer patients.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ando N.
        • Ozawa S.
        • Kitagawa Y.
        • Shinozawa Y.
        • Kitajima M.
        Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years.
        Ann Surg. 2000; 232: 225-232
        • Gockel I.
        • Sultanov F.S.
        • Domeyer M.
        • Goenner U.
        • Junginger T.
        Developments in esophageal surgery for adenocarcinoma: a comparison of two decades.
        BMC Cancer. 2007; 7: 114
        • Dionigi G.
        • Rovera F.
        • Boni L.
        • et al.
        The surgeon's approach to preoperative evaluation of esophageal cancer: recent developments.
        Rays. 2005; 30: 351-356
        • Matsubara H.
        Neoadjuvant chemoradiation therapy for the treatment of esophageal carcinoma.
        Int J Clin Oncol. 2008; 13: 474-478
        • Fiorica F.
        • Di Bona D.
        • Schepis F.
        • Licata A.
        • Shahied L.
        • Venturi A.
        • et al.
        Preoperative chemoradiotherapy for oesophageal cancer: a systematic review and meta-analysis.
        Gut. 2004; 53: 925-930
        • Gebski V.
        • Burmeister B.
        • Smithers B.M.
        • Foo K.
        • Zalcberg J.
        • Simes J.
        • et al.
        Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis.
        Lancet Oncol. 2007; 8: 226-234
        • Atkins B.Z.
        • Shah A.S.
        • Hutcheson K.A.
        • Mangum J.H.
        • Pappas T.N.
        • Harpole Jr., D.H.
        • et al.
        Reducing hospital morbidity and mortality following esophagectomy.
        Annals Thorac Surg. 2004; 78: 1170-1176
        • Dumont P.
        • Wihlm J.M.
        • Hentz J.G.
        • Roeslin N.
        • Lion R.
        • Morand G.
        Respiratory complications after surgical treatment of esophageal cancer. A study of 309 patients according to the type of resection.
        Eur J Cardiothorac Surg. 1995; 9: 539-543
        • Abunasra H.
        • Lewis S.
        • Beggs L.
        • Duffy J.
        • Beggs D.
        • Morgan E.
        Predictors of operative death after oesophagectomy for carcinoma.
        Br J Surg. 2005; 92: 1029-1033
        • Akutsu Y.
        • Matsubara H.
        • Okazumi S.
        • Shimada H.
        • Shuto K.
        • Shiratori T.
        • et al.
        Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients.
        Dig Surg. 2008; 25: 93-97
        • Akutsu Y.
        • Matsubara H.
        • Shuto K.
        • Uesato M.
        • Mori M.
        • Hoshino I.
        • et al.
        Clinical and pathologic evaluation of the effectiveness of neoadjuvant chemoradiation therapy in advanced esophageal cancer patients.
        World J Surg. 2009; 33: 1002-1009
        • Isono K.
        • Sato H.
        • Nakayama K.
        Results of a nationwide study on the three-field lymph node dissection of esophageal cancer.
        Oncology. 1991; 48: 411-420
        • Okazumi S.
        • Ochiai T.
        • Shimada H.
        • Matsubara H.
        • Nabeya Y.
        • Miyazawa Y.
        • et al.
        Development of less invasive surgical procedures for thoracic esophageal cancer.
        Dis Esophagus. 2004; 17: 159-163
        • Shimada H.
        • Ochiai T.
        • Okazumi S.
        • Matsubara H.
        • Nabeya Y.
        • Miyazawa Y.
        • et al.
        Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer.
        Surgery. 2000; 128: 791-798
        • El-Solh A.A.
        • Pietrantoni C.
        • Bhat A.
        • Okada M.
        • Zambon J.
        • Aquilina A.
        • et al.
        Colonization of dental plaques: a reservoir of respiratory pathogens for hospital-acquired pneumonia in institutionalized elders.
        Chest. 2004; 126: 1575-1582
        • Ford S.J.
        The importance and provision of oral hygiene in surgical patients.
        Int J Surg. 2008; 6: 418-419
        • Paju S.
        • Scannapieco F.A.
        Oral biofilms, periodontitis, and pulmonary infections.
        Oral Dis. 2007; 13: 508-512
        • Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract
        Selective Decontamination of the Digestive Tract Trialists' Collaborative Group.
        BMJ. 1993; 307: 525-532
        • Farran L.
        • Llop J.
        • Sans M.
        • Kreisler E.
        • Miró M.
        • Galan M.
        • et al.
        Efficacy of enteral decontamination in the prevention of anastomotic dehiscence and pulmonary infection in esophagogastric surgery.
        Dis Esophagus. 2008; 21: 159-164
        • Sumi Y.
        • Miura H.
        • Michiwaki Y.
        • Nagaosa S.
        • Nagaya M.
        Colonization of dental plaque by respiratory pathogens in dependent elderly.
        Arch Gerontol Geriatr. 2007; 44: 119-124
        • Schaefer H.
        • Engert A.
        • Grass G.
        • Mansmann G.
        • Wassmer G.
        • Hubel K.
        • et al.
        Perioperative granulocyte colony-stimulating factor does not prevent severe infections in patients undergoing esophagectomy for esophageal cancer: a randomized placebo-controlled clinical trial.
        Ann Surg. 2004; 240: 68-75
        • Lee H.K.
        • Vaporciyan A.A.
        • Cox J.D.
        • Tucker S.L.
        • Putnam Jr., J.B.
        • Ajani J.A.
        • et al.
        Postoperative pulmonary complications after preoperative chemoradiation for esophageal carcinoma: correlation with pulmonary dose-volume histogram parameters. Int. J Radiat.
        Oncol. Biol. Phys. 2003; 57: 1317-1322
        • Atkins B.Z.
        • Fortes D.L.
        • Watkins K.T.
        Analysis of respiratory complications after minimally invasive esophagectomy: preliminary observation of persistent aspiration risk.
        Dysphagia. 2007; 22: 49-54
        • Fukuda T.
        • Seto Y.
        • Yamada K.
        • Hiki N.
        • Fukunaga T.
        • Oyama S.
        • et al.
        Can immune-enhancing nutrients reduce postoperative complications in patients undergoing esophageal surgery?.
        Dis Esophagus. 2008; 21: 708-711