The Relationship Between Postoperative Pneumonia and Oral Environment in Esophageal Cancer Patients at Our Hospital

ABSTRACT Introduction Surgery for esophageal cancer may induce postoperative pneumonia due to its high‐degree invasiveness and a reduction in the swallowing function/sputum‐excreting capacity after surgery. Pulmonary aspiration of oral/pharyngeal fluid containing pathogenic microorganisms may be involved in the pathogenesis of postoperative pneumonia. Perioperative oral care may reduce the number of oral bacteria, preventing its onset. In this study, we examined the relationship between pneumonia after video‐assisted thoracic surgery‐esophagectomy and the oral environment before surgery in perioperative‐phase patients with esophageal cancer at our hospital. Subjects and Methods The subjects were 92 patients who underwent video‐assisted thoracic surgery‐esophagectomy (VATS‐E) under a diagnosis of thoracic esophageal cancer in the Department of Digestive Surgery at our university between January 1, 2015, and December 31, 2016, followed by oral care in the Department of Dentistry at our university. As the survey items, the scoring of the oral environment before VATS‐E was performed using the Revised Oral Assessment Guide (ROAG) and statistically investigated in addition to the age, sex, smoking, alcohol consumption, history of diabetes mellitus, hematological data (total protein [TP] and albumin [ALB]), respiratory function test value (forced expiratory volume% in 1 s), operative time, volume of blood loss, postoperative pneumonia, dysphagia, and respiratory disorder. Prior to this study, its protocol was approved by the ethics review board of our university (ERB‐C‐1079‐1). Results Post‐VATS‐E pneumonia was observed in 22% of the subjects. Of these, dysphagia/respiratory dysfunction accounted for 35%, smoking for 15%, and alcohol consumption for 5%. In ≥ 50%, both alcohol consumption and smoking were present. Of the subjects, dysphagia was noted in 13%; it was associated with pneumonia. In patients with a favorable oral environment, the rates of change in the ALB and TP levels before and after VATS‐E were significantly ameliorated in comparison with those with a poor oral environment, suggesting its association. Conclusion There was an association between post‐VATS‐E pneumonia and dysphagia. In patients with a favorable oral environment before surgery, there was an improvement in the systemic nutritional status after VATS‐E. Furthermore, smoking and alcohol consumption, as risk factors for esophageal cancer, were present in many patients with post‐VATS‐E pneumonia. Thus, thorough perioperative oral care and patient education may be necessary in the future.