Association between bacterial colonization on the tumor, bacterial translocation to the cervical lymph nodes and subsequent postoperative infection in patients with oral cancer

Objective: To investigate the association between postoperative infection, bacterial translocation to the cervical lymph nodes and bacterial colonization on the tumor in oral cancer patients.
Methods: Twenty-one oral mucosal cancer patients (11 male and 10 females: mean age 68.6 years) were studied. They underwent tumor surgery and neck dissection with free flap reconstruction. Ampicillin 1 g was parenterally administered from the start of the surgery as prophylaxis. Isolates from cervical lymph nodes, tumor and postoperative infected wound were studied microbiologically and pathologically.
Results: Bacterial translocation was found in 52 lymph nodes (52/107: 48.6%). Viable bacteria were isolated from 20 tumors (95.2%). Oral microflora and enteric bacteria were isolated. Postoperative infection was found in four cases. In three cases, enteric bacteria ( Klebsiella, Enterobacter, Enterococcus ) isolated from postoperative infections were also found in the tumor or the lymph nodes.
Conclusions: The operative field in oral cancer surgery was colonized by the indigenous flora and enteric bacteria. These were recovered not only from the tumor surface but also from the cervical lymph nodes. Preoperative surveillance culture or tumor culture have value in predicting the bacteriology of postoperative infection, and in selecting the appropriate antibiotic treatment.