Department of Surgery, Kochi Medical School, Nankoku, Kochi, Japan.
J Gastroenterol Hepatol. 2013 Sep;28(9):1457-61. doi: 10.1111/jgh.12219.
Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI.
In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study. Patients with plasma βDG levels >11 pg/mL (the cut-off value) were randomly assigned to either receive antifungal treatment or not (n=13 in each group). Postoperative outcomes were assessed using various clinical parameters.
After gastric cancer surgery, plasma βDG levels were ≥11 pg/mL in 26 of 81 elderly patients (32.1%). Of the βDG-positive patients, significantly more had stages III and IV rather than stages I and II disease (44.1% vs 23.4%, respectively; P=0.049). Fever on postoperative day 8 was significantly reduced in the pre-emptive antifungal-treated group than in the control group (36.8°C vs 37.2°C, respectively; P=0.045). However, there were no significant differences in mortality, morbidity, βDG levels, white blood cell count, and C-reactive protein levels between the two groups.
Pre-emptive antifungal treatment based on βDG after gastric surgery in elderly patients may help reduce the incidence of postoperative fever and suppress IFI. However, this needs to be confirmed in a larger prospective randomized, controlled trial.
老年患者外科手术后侵袭性真菌感染（IFI）常与高发病率和高死亡率相关。本研究旨在确定老年胃癌手术患者术后 1,3-β-D-葡聚糖（βDG）水平，并前瞻性评估以βDG 为辅助手段早期诊断 IFI 的预防性抗真菌治疗的疗效。
2009 年至 2011 年间，81 例年龄≥70 岁的胃癌手术患者前瞻性入组本研究。βDG 水平>11pg/mL（临界值）的患者被随机分为接受或不接受抗真菌治疗（每组各 13 例）。使用各种临床参数评估术后结局。
81 例老年患者中，26 例（32.1%）术后βDG 水平≥11pg/mL。βDG 阳性患者中，III 期和 IV 期患者明显多于 I 期和 II 期患者（分别为 44.1%和 23.4%；P=0.049）。预防性抗真菌治疗组术后第 8 天发热的患者显著少于对照组（分别为 36.8°C 和 37.2°C；P=0.045）。然而，两组间死亡率、发病率、βDG 水平、白细胞计数和 C 反应蛋白水平均无显著差异。
基于胃癌手术后老年患者βDG 的预防性抗真菌治疗可能有助于降低术后发热的发生率并抑制 IFI。然而，这需要在更大的前瞻性随机对照试验中得到证实。
