Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery

• Published in: Annals of surgery 2000, Vol.231 (1), p.88-95
• Main Authors: KANWAR, S, WINDSOR, A. C. J. W, WELSH, F, BARCLAY, G. R, GUILLOU, P. J, REYNOLDS, J. V
• Format: Article
• Language: English
• Subjects: Acute-Phase Reaction - physiopathology; Aged; Bacterial Translocation - physiology; Biological and medical sciences; Cell Membrane Permeability - physiology; Endotoxins - blood; Esophageal Neoplasms - physiopathology; Esophageal Neoplasms - surgery; Female; Humans; Intestinal Mucosa - physiopathology; Male; Medical sciences; Middle Aged; Original; Pancreatic Neoplasms - physiopathology; Pancreatic Neoplasms - surgery; Postoperative Complications - physiopathology; Risk Factors; Stomach Neoplasms - physiopathology; Stomach Neoplasms - surgery; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Systemic Inflammatory Response Syndrome - physiopathology; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200001000-00013

To determine the influence of abnormal gut barrier function on the risk of septic complications in patients undergoing major resectional surgery for upper gastrointestinal cancer. A failure of the gut mucosal barrier to exclude bacteria and endotoxin from the portal and systemic circulation is incriminated in the development of sepsis and multiple organ failure. Although the experimental data is compelling, corroborative evidence from studies in humans is sparse. This study attempted to correlate both preoperative gut barrier dysfunction and the pattern of change after surgery with septic outcome. Sixty-eight patients undergoing curative resectional surgery for upper gastrointestinal cancer were monitored for 30-day septic morbidity (intraabdominal abscesses/empyema and pneumonia). Intestinal permeability, serum IgM and IgG anti-endotoxin antibodies (EndoCAb), and serum C-reactive protein were measured before surgery and on postoperative days 1 and 7. Increased intestinal permeability before surgery did not predict septic outcome. Major surgery was associated with increased intestinal permeability and evidence of endotoxin exposure. Comparing sepsis and nonsepsis groups, however, there was no significant difference in intestinal permeability, endotoxin exposure, and the acute phase response after surgery. This study demonstrates that gut barrier dysfunction occurs after surgery, but the magnitude of change does not differentiate patients in whom sepsis develops and those in whom it does not. Preoperative increased intestinal permeability had no predictive value for sepsis. This study failed to support the thesis that gut barrier dysfunction is directly linked to sepsis.