The detection of intraoperative bacterial translocation in the mesenteric lymph nodes is useful in predicting patients at high risk for postoperative infectious complications after esophagectomy.
Ann Surg
; 259(3): 477-84, 2014 Mar.
Article
em En
| MEDLINE
| ID: mdl-23549427
ABSTRACT
OBJECTIVE:
To investigate the incidence of BT in the mesenteric lymph node and bacteremia after an esophagectomy using a bacterium-specific ribosomal RNA-targeted reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR).BACKGROUND:
There is little evidence regarding the occurrence of bacterial translocation (BT) and its correlation to postoperative infectious complications after an esophagectomy.METHODS:
Eighteen patients with esophageal cancer were studied. Mesenteric lymph nodes were harvested from the jejunal mesentery before surgical mobilization (MLN-1) and after the restoration of bowel continuity (MLN-2). Blood and sputum were also sampled before surgery (Blood-1 and Sputum-1) and on postoperative day 1 (Blood-2 and Sputum-2).RESULTS:
The detection rates of bacteria in the MLN-2 (56%) and Blood-2 (56%) were significantly higher than those in the MLN-1 (17%) and Blood-1 (22%), indicating that surgical stress induces BT. The detection rate was not different between Sputum-1 (80%) and Sputum-2 (78%). There was an 80% sequence homology between the RT-qPCR products in the MLN-2 and Blood-2, whereas the homology was only 20% between Blood-2 and Sputum-2. In the patients with positive bacteria in the MLN-2 sample, there was a greater incidence of postoperative infectious complications than in patients without bacteria in the MLN-2 sample (P = 0.04). The postoperative hospital stay was also longer (P = 0.037) for patients with positive bacteria in the MLN-2 sample.CONCLUSIONS:
BT frequently occurs during esophagectomies, and postoperative bacteremia is likely to be gut-derived. Patients with positive bacteria in the MLN-2 sample should be carefully managed because these patients are more susceptible to postoperative infectious complications.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecção da Ferida Cirúrgica
/
Bactérias
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RNA Bacteriano
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Neoplasias Esofágicas
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Esofagectomia
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Translocação Bacteriana
/
Linfonodos
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
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Observational_studies
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Prognostic_studies
/
Risk_factors_studies
Limite:
Aged80
/
Female
/
Humans
/
Male
País como assunto:
Asia
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article