Sensitivity and specificity of the question "do you have any concerns regarding your mouth related to undergoing surgery?" for predicting perioperative oral health problems in patients with primary esophageal and lung cancer: a retrospective observational study.

BACKGROUND: Perioperative oral management contributes to the prevention of dental/systemic complications. However, a professional dental checkup before surgery is generally not performed and relies on the patient's answer to a simple question by medical professionals other than dentists: "Do you have any concerns regarding your mouth related to undergoing surgery?" Here, we evaluated the sensitivity and specificity of this question for predicting perioperative oral health problems in patients with primary esophageal and primary lung cancer. METHODS: We performed an oral cavity check in all patients before scheduled surgery for primary esophageal and lung cancer. A total of 183 patients were enrolled (M, 112; F, 71; 24-88 years, median, 69 years), consisting of 61 with primary esophageal cancer (M, 46; F, 15; 24-85 years, median, 69 years) and 122 with primary lung cancer (M, 66; F; 56; 33-88 years, median, 69 years). All subjects provided a response to this question, and an oral cavity check was performed by dentists. The sensitivity and specificity of this question for detecting oral health problems were evaluated retrospectively. RESULTS: Overall sensitivity and specificity for detecting oral health problems were 0.263 and 0.898, respectively. There were no significant differences by sex or disease (primary esophageal or lung cancer). CONCLUSION: This simple question has low sensitivity but high specificity for detecting oral health problems. Although challenging to detect surgical patients with oral health problems by simply asking questions, the results indicated that patients with oral complaints are more likely to have problems during surgery.

Early intervention of the perioperative multidisciplinary team approach decreases the adverse events during neoadjuvant chemotherapy for esophageal cancer patients.

BACKGROUND: Multidisciplinary team (MDT) approach has become a standard for perioperative patient care, including in esophageal cancer. In our institution, the Perioperative Management Center (PERiO) has been doing an MDT approach for patients undergoing esophageal cancer surgery since 2009. On the other hand, neoadjuvant therapy has also been becoming standard for many malignancies, including esophageal cancer. In Japan, neoadjuvant chemotherapy (NAC) for esophageal cancer is standard now. However, there have been no reports about when is the best time to start the MDT approach for patients with neoadjuvant therapy. In this study, the best start time for the MDT approach for esophageal cancer patients with NAC was examined from the perspective of adverse events during chemotherapy and perioperative period. METHODS: All cases underwent thoracoscopic esophagectomy in the prone position (TEPP) after NAC. The PERiO Intervention group that started before NAC (n = 100) was compared with the PERiO Intervention group that started after NAC (n = 77). Eventually, 54 paired cases were matched by propensity score matching. RESULTS: The adverse event rate during chemotherapy, especially oral complications, was significantly decreased in the PERiO Intervention started before the NAC group (P = 0.007). Furthermore, weight loss during the period from chemotherapy to surgery was significantly reduced in the group that started before NAC (P = 0.033). CONCLUSION: The MDT approach should be started before NAC in patients undergoing esophageal cancer surgery to prevent adverse events during chemotherapy and provide safe perioperative conditions.

Is the use of ultrasound-derived prediction equations for adults useful for estimating total and regional skeletal muscle mass in Japanese children?

The purpose of the present study was to investigate whether ultrasound-derived prediction equations for estimating total and regional skeletal muscle (SM) mass in adults are applicable for prepubertal children and adolescents. Ten Japanese prepubertal children and twenty-one adolescents volunteered for the study. Contiguous MRI images with a 1 cm slice thickness were obtained from the first cervical vertebra to the ankle joints as reference data. The SM volume was calculated from the summation of digitised cross-sectional areas. The regional SM volume was determined by anatomical landmarks visible in the scanned images. The volume units were converted into mass by an assumed SM density (1.041 g/cm3). Muscle thickness was measured by B-mode ultrasound at nine sites on different muscles (lateral forearm, anterior and posterior upper arm, abdomen, subscapular, anterior and posterior thigh, anterior and posterior lower leg). Total and regional SM mass was estimated using adult prediction equations. Mean values between measured and predicted total and regional segments of SM mass were not significantly different for adolescents, but were for prepubertal children. There was a relatively large range of the 95% limits of agreement both in prepubertal children and adolescents. These results suggest that the adult ultrasound-derived prediction equations are useful for estimating total and regional SM mass for adolescents at the group level, but the relatively high degree of variability suggested limited reliability at the individual level both in prepubertal children and adolescents.