Department of Surgery, Osaka International Cancer Institute, 3-1-69 Otemae, Osaka, Chuo-ku, 541-8567, Japan.
Department of Surgery, Osaka General Medical Center, 3-1-56 Bandai-higashi, Osaka, 558-8558, Japan.
BMC Gastroenterol. 2020 Mar 16;20(1):74. doi: 10.1186/s12876-020-01217-y.
The intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer.
Fifty-five patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Perioperative synbiotics were administered to all patients. Perioperative clinical characteristics and concentrations of preoperative fecal organic acids were compared between patients with and without postoperative infectious complications.
Postoperative infectious complications occurred in 10 patients. In patients with complications, the concentrations of acetic acid and propionic acid were significantly lower than in patients without complications (p = 0.044 and 0.032, respectively). The concentration of butyric acid was nonsignificantly lower in patients with complications, while the concentration of lactic acid was nonsignificantly higher. The calculated gap between the concentrations of fecal acetic acid plus propionic acid plus butyric acid minus lactic acid was significantly lower in patients with complications. Multivariate analysis revealed that a low gap between acetic acid plus propionic acid plus butyric acid minus lactic acid was an independent risk factor for postoperative infectious complications (p = 0.027).
Preoperative fecal concentrations of organic acids had a clinically important impact on the occurrence of postoperative infectious complications in patients with esophageal cancer. To reduce postoperative infectious complications, it may be useful to modulate the intestinal environment and maintain concentrations of fecal organic acids before surgery.
肠道上皮屏障允许吸收膳食营养素，并防止病原体和毒素进入体内。严重的损伤会对肠道环境产生负面影响，从而可能降低肠道屏障功能并导致细菌易位。细菌易位可引起感染性并发症，其定义为微生物从胃肠道穿过黏膜屏障转移到肠外部位。本研究旨在探讨术前粪便有机酸浓度与食管癌患者术后感染性并发症发生的相关性。
本研究纳入了 55 例行食管癌切除术的患者。所有患者均给予围手术期共生元治疗。比较了有和无术后感染性并发症患者的围手术期临床特征和术前粪便有机酸浓度。
10 例患者发生术后感染性并发症。在有并发症的患者中，乙酸和丙酸的浓度明显低于无并发症的患者（p=0.044 和 0.032）。有并发症的患者中丁酸浓度略低，但乳酸浓度略高。有并发症的患者粪便中乙酸+丙酸+丁酸-乳酸的差值明显较低。多变量分析显示，术前粪便中乙酸+丙酸+丁酸-乳酸的差值低是术后感染性并发症的独立危险因素（p=0.027）。
术前粪便有机酸浓度对食管癌患者术后感染性并发症的发生具有重要的临床影响。为了降低术后感染性并发症的发生，术前调节肠道环境和维持粪便有机酸浓度可能是有用的。
