Effect of Perioperative Gum Chewing Training in Esophageal Cancer Patients

Objectives: We reported that tongue pressure after esophagectomy (34.2±7.3kPa) were significantly decreased than that before esophagectomy (35.6±7.3kPa) in esophageal cancer patients (n=59, 64.2±6.9yrs) (Yokoi et al., Esophagus, 2019). Because decreasing tongue pressure relates to dysphagia, preventing from decreasing tongue pressure after esophagectomy is required to improve prognosis. The purpose of this study was to investigate the relation between perioperative gum chewing training and tongue pressure in thoracic esophageal cancer patients.
Methods: This study was approved by Ethics Committee in Okayama University (Rin2009-007). A single-facility, propensity-matched pre-post study was conducted. The subjects were 22 patients with thoracic esophageal cancer who were scheduled to esophagectomy after April 2021 in Okayama University Hospital (66.1±9.5yrs, 18 males and 4 females). They performed gum chewing training about 5 minutes, 3 times per day during perioperative period. Another subject group in our previous study was used as Control group, and propensity score matching (age, sex, and repetitive saliva swallowing test and tongue pressure before esophagectomy) was used to minimize selection bias. In both groups, tongue pressure was evaluated at before and 2 weeks after esophagectomy. To compare between Control and Gum group, χ² test and Mann-Whitney U test was used.
Results: Duration of gum chewing training period before esophagectomy was 14.9±6.2 days. One patient dropped out from this study, and the data of 21 patients in Gum group were compared with 22 patients in propensity score matched Control group. The rate of the patients whose tongue pressure decreased after esophagectomy was 38.1% in the Gum group, and significantly fewer than 72.7% in the Control group (p=0.02). Differences in tongue pressure (2 weeks after esophagectomy - before esophagectomy) in Gum group were significantly more than those in Control group (p=0.02).
Conclusions: Perioperative gum chewing training prevented from decreasing tongue pressure after esophagectomy in thoracic esophageal cancer patients.