Jørgensen Anders Bech, Almer Louise, Samaniego Castruita Jose Alfredo, Pedersen Martin Schou, Kirkby Nikolai Søren, Jensen Esther Agnete, Alfaro-Núñez Alonzo, Friis-Hansen Lennart, Brandstrup Birgitte
Department of Surgery, Part of Copenhagen University Hospitals - Holbæk, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Heliyon. 2024 Nov 22;10(23):e40616. doi: 10.1016/j.heliyon.2024.e40616. eCollection 2024 Dec 15.
Anastomotic leakage (AL) is a severe complication of colorectal surgery. The risk of AL is affected by both surgery and patient factors. Gut microbiomes can be generated from the residual material from the fecal immunochemical test (FIT). We, therefore, examined if AL after colorectal cancer surgery could be associated with specific baseline microbiomes in the FIT screening sampling tubes collected weeks before surgery.
Samples from patients participating in the Danish colorectal cancer screening program were biobanked from 2016 to 2018, and samples from patients who had surgery for screening-detected cancer were included. They were matched with patients without AL in a 1:2 ratio based on age, sex, location of anastomosis (colonic/rectal), ASA classification, and smoking habits. Bacterial DNA was extracted from the sampling tubes, and the fecal microbiomes were analyzed with targeted 16S ribosomal RNA third-generation sequencing.
18 patients who developed AL after surgery were matched with 36 without AL. The alpha diversity was lower in the AL group (p = 0.035), and the AL group separated from the Controls in the PCoA plot (p < 0.001). This was due to the patients undergoing rectal resections, with significant differences in alpha- and beta diversity (p = 0.025 and p = 0.002, respectively). The prevalence of bacteria with the potential to produce collagenase was higher in patients who developed AL (odds ratio 1.29 (95% CI 1.28-1.30), p < 0.001).
We found differences in the baseline microbiome profile associated with subsequent development of AL after surgery for screening-detected rectal cancer.
吻合口漏（AL）是结直肠手术的一种严重并发症。AL的风险受手术和患者因素的影响。肠道微生物群可由粪便免疫化学检测（FIT）的残留物质产生。因此，我们研究了结直肠癌手术后的AL是否与手术前几周收集的FIT筛查采样管中的特定基线微生物群有关。
2016年至2018年对参与丹麦结直肠癌筛查项目的患者样本进行生物样本库保存，纳入因筛查发现癌症而接受手术的患者样本。根据年龄、性别、吻合口位置（结肠/直肠）、美国麻醉医师协会（ASA）分级和吸烟习惯，将他们与无AL的患者按1:2的比例进行匹配。从采样管中提取细菌DNA，并用靶向16S核糖体RNA第三代测序分析粪便微生物群。
18例术后发生AL的患者与36例无AL的患者进行匹配。AL组的α多样性较低（p = 0.035），在主坐标分析（PCoA）图中AL组与对照组分离（p < 0.001）。这是由于接受直肠切除术的患者，其α和β多样性存在显著差异（分别为p = 0.025和p = 0.002）。发生AL的患者中具有产生胶原酶潜力的细菌患病率较高（优势比1.29（95%可信区间1.28 - 1.30），p < 0.001）。
我们发现，筛查发现的直肠癌手术后，与随后发生AL相关的基线微生物群特征存在差异。
