Effect on Outcomes


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In a recent study, researchers in Japan used a nationwide administrative claims database in a retrospective cohort study to identify 509,179 patients who underwent surgery for head and neck, gastric, esophageal, lung, colorectal, or liver cancer between May 2012 and December 2015. Of these patients, 16.0% (81,632) received preoperative oral care from a dentist.1

The primary end points of this study were postoperative pneumonia and all-cause mortality in the initial 30 days following surgery. A little more than 3% of patients (15,724) experienced postoperative pneumonia, and 0.34% of patients (1,734) died within the first 30 days following surgery.1

After adjusting for potential confounding factors, 3.28% of patients who underwent preoperative oral care from a dentist experienced postoperative pneumonia, a significant decrease from the 3.76% of patients who did not undergo preoperative oral care and developed postoperative pneumonia (risk difference, –0.48%; 95% confidence interval [CI], –0.64 to –0.32).1

Similarly, all-cause mortality within the first 30 days after surgery was 0.30% in patients who underwent preoperative oral care from a dentist vs 0.42% in patients who did not receive oral care (risk difference, –0.12%; 95% CI, –0.17 to –0.07).1

Conclusions

Guidelines are not yet established for including preoperative and perioperative oral care for patients undergoing surgery as part of their planned cancer therapy. One group assessing bacterial load and salivary function in patients with esophageal cancer noted, “[T]here is a great need for an oral health care clinical approach for esophagectomized patients during the perioperative period.”6

In addition, prospective, randomized studies are needed to address which specific oral care procedures are most efficacious at improving clinical outcomes, reducing pneumonia, and reducing mortality in cancer patients undergoing surgery. 

In the absence of such studies, the accumulation of study results still suggests healthcare providers should recommend preoperative oral care in patients with cancer, particularly those with gastrointestinal, esophageal, and/or head and neck cancers. 

Such preoperative care could reduce the pathogenic bacterial load in the oral cavity, thereby reducing the risk of postoperative pneumonia developing and its associated mortality risk. Ideally, preoperative oral care would include instruction on postoperative oral hygiene to further improve outcomes.

References

1. Ishimaru M, Matsui H, Ono S, Hagiwara Y, Morita K, Yasunaga H. Preoperative oral care and effect on postoperative complications after major cancer surgery [published online August 8, 2018]. Br J Surg. 2018. doi: 10.1002/bjs.10915

2. 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(2):225-232.

3. Sato M, Yoshihara A, Miyazaki H. Preliminary study on the effect of oral care on recovery from surgery in elderly patients. J Oral Rehabil. 2006;33(11):820-826.

4. Soutome S, Yanamoto S, Funahara M, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: a multicenter case-control study with propensity score matching analysis. Medicine (Baltimore). 2017;96(33):e7436.

5. Akutsu Y, Matsubara H, Okazumi S, et al. Impact of preoperative dental plaque culture for predicting postoperative pneumonia in esophageal cancer patients. Dig Surg. 2008;25(2):93-97.

6. Yoshioka M, Hinode D, Yamamoto Y, Furukita Y, Tangoku A. Alteration of the oral environment in patients undergoing esophagectomy during the perioperative period. J Appl Oral Sci. 2013;21(2):183-189.