W. B. Weir1, K. M. Thompson1, C. Garaicoa-Pazmino2, C. Tsai2, J. Lin1, P. Carrott1, W. Lynch1, M. Orringer1, A. Chang1, J. Fenno2, Y. Kapilla2, R. M. Reddy1 1University Of Michigan Health System,Department Of Surgery, Section Of Thoracic Surgery,Ann Arbor, MI, USA 2University Of Michigan School Of Dentistry,Division Of Periodontics, Department Of Periodontics And Oral Medicine,Ann Arbor, MI, USA
Introduction: Postoperative anastomotic leaks after esophagectomy for esophageal cancer remain a significant source of morbidity and mortality. Periodontal disease has been associated with post-operative infections in esophagectomy and brain-surgery patients. We hypothesized that preoperative periodontal disease may result in a higher incidence of postoperative anastomotic leak and morbidity after esophagectomy.
Methods: A prospective study of esophagectomy patients was performed from May 2013 to August 2014, beginning with a periodontal health survey administered to the patients prior to surgery. Risk factors for periodontal disease included prior tooth extraction, gum treatment, tooth replacement, bleeding gums, teeth cleaning greater than one year prior to survey enrollment, teeth brushing less than twice per day, flossing less than daily, and diabetes. Patients were risk stratified into low risk (1-2 risk factors) and high risk (≥ 3 risk factors) for periodontal disease. Primary outcomes analyzed were elevated pre- and postoperative white blood cell count (WBC), postoperative anastomotic leak, length of stay, and readmission after discharge. The data was analyzed using a Chi-square and student's t-test.
Results: 66 patients were enrolled, 55 patients completed the survey and underwent successful esophagectomy. Among those, 80% (44) had a diagnosis of adenocarcinoma, 13% (7) had squamous cell carcinoma, and 7% (4) had benign disease. The 30-day mortality was 2% (1).
All patients had at least 1 risk factor for periodontal disease. Approximately 27% (15) of patients were considered low risk for periodontal disease and 73% (40) were high risk. Periodontal disease did not correlate with the mean difference between pre- and postoperative WBC (low risk group 7.77, high risk group 6.84, p = 0.56). Nor was periodontal disease a risk factor for the development of anastomotic leak (p = 0.63). The mean length of stay was longer for the low risk group than for the high risk group (13.5 days vs. 9.75 days, p < 0.001). There was no difference in re-admission rates between the groups (p = 0.2).
Conclusion: Risk factors for periodontal disease were present in all of our esophagectomy patients. Higher numbers of risk factors did not correlate with worse outcomes. As all patients had some risk of periodontal disease, there may be an association between periodontal disease and esophageal cancer development.