Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Clinical Trial Planning and Management, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
Ann Surg. 2020 Dec;272(6):1035-1043. doi: 10.1097/SLA.0000000000003287.
The aim of this study was to clarify the correlation between oropharyngeal microflora and postoperative complications as well as long-term survival after esophagectomy.
Although the oral cavity is known to be a potential reservoir for pathogens, the influence of abnormal oropharyngeal microflora on the outcomes of patients undergoing esophagectomy remains unknown.
This study included 675 patients who underwent esophagectomy between 2007 and 2014. Saliva samples from the oropharynx were collected 2 days before the operation. There were 442 patients with indigenous flora (Ind group) and 233 with allopatric flora. Among the patients with allopatric flora, 140 had antibiotic-sensitive microbes only (Allo-S group) while 93 had different types of antibiotic-resistant microbes (Allo-R group). We investigated the correlation between the types of oropharyngeal microflora and the incidence of postoperative complications as well as long-term outcomes.
Sixteen microbes could be cultivated from the saliva samples. The incidence of postoperative pneumonia in the Allo-S and Allo-R groups was significantly higher than in the Ind group (P < 0.001). In addition, acute respiratory distress syndrome was more often observed in the Allo-R group than in the other groups (P = 0.002). A significantly higher rate of antibiotic use and longer hospital stays were observed in the Allo-R group compared with the Ind group. Multivariate logistic regression analysis revealed that the presence of allopatric antibiotic-resistant microbes in the oropharynx was an independent risk factor for postoperative pneumonia (odds ratio, 3.93; 95% confidence interval, 2.41-6.42). The overall survival was significantly poorer in the Allo-R group than in the other groups.
Preoperative oropharyngeal culture is a simple and low-cost method that can predict both the occurrence of postoperative pneumonia and poor prognosis after esophagectomy.
本研究旨在阐明口咽微生物群与食管癌术后并发症及长期生存的相关性。
虽然口腔被认为是病原体的潜在储库，但异常口咽微生物群对口咽癌患者手术结果的影响尚不清楚。
本研究纳入了 2007 年至 2014 年间接受食管癌切除术的 675 例患者。在手术前 2 天采集口咽唾液样本。442 例患者为固有菌群（Ind 组），233 例患者为异位菌群。在异位菌群患者中，140 例仅存在抗生素敏感微生物（Allo-S 组），93 例存在不同类型的抗生素耐药微生物（Allo-R 组）。我们研究了口咽微生物群的类型与术后并发症的发生率以及长期结果之间的相关性。
从唾液样本中培养出 16 种微生物。Allo-S 组和 Allo-R 组术后肺炎的发生率明显高于 Ind 组（P < 0.001）。此外，Allo-R 组急性呼吸窘迫综合征的发生率高于其他组（P = 0.002）。Allo-R 组抗生素使用和住院时间明显长于 Ind 组。多变量逻辑回归分析显示，口咽存在异位抗生素耐药微生物是术后肺炎的独立危险因素（比值比，3.93；95%置信区间，2.41-6.42）。Allo-R 组的总生存率明显低于其他组。
术前口咽培养是一种简单且低成本的方法，可预测食管癌术后肺炎的发生和预后不良。
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