The Association Between Intraoperative Compromised Intestinal Integrity and Postoperative Complications in Cancer Patients.

Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
15 Jan 2024
Historique:
received: 04 01 2023
accepted: 17 12 2023
medline: 16 1 2024
pubmed: 16 1 2024
entrez: 15 1 2024
Statut: aheadofprint

Résumé

Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied. Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications. A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0-142.0) to 115 pg/mL at T1 (IQR 48.0-198.0) (p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08) and anesthesia time (OR 1.13, 95% CI 1.02-1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86-260) versus 113% (IQR 44-184) respectively (p < 0.05). A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.

Sections du résumé

BACKGROUND BACKGROUND
Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied.
METHODS METHODS
Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications.
RESULTS RESULTS
A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0-142.0) to 115 pg/mL at T1 (IQR 48.0-198.0) (p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08) and anesthesia time (OR 1.13, 95% CI 1.02-1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86-260) versus 113% (IQR 44-184) respectively (p < 0.05).
CONCLUSIONS CONCLUSIONS
A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.

Identifiants

DOI: 10.1245/s10434-023-14857-7 PMID: 38225477
pubmed: 38225477
doi: 10.1245/s10434-023-14857-7
pii: 10.1245/s10434-023-14857-7
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2024. The Author(s).

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Auteurs

Sharon Hendriks (S)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. s.hendriks@umcg.nl.
ORCID: 0000-0002-7551-1599

Monique G Huisman (MG)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Suzanne C Stokmans (SC)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Matthijs Plas (M)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Hanneke van der Wal-Huisman (H)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Barbara C van Munster (BC)

Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Anthony R Absalom (AR)

Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Gertrude J Nieuwenhuijs-Moeke (GJ)

Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Geertruida H de Bock (GH)

Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Barbara L van Leeuwen (BL)

Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Jacco J de Haan (JJ)

Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Classifications MeSH