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Published on: December 18, 2010
Prognostic Role of Bacterial Translocation, Serum Endotoxin, and ZO-1 in Postoperative Infections Following
Nikolaos Benetatos1, Dimitra Georgakopoulou2, Anne-Lise DE Lastic2
1Department of Surgery, University Hospital of Patras, Patras, Greece; nikosbenetatos@gmail.com.
Background/Aim:
Bacterial translocation (BT) is linked to increased postoperative infections in oncologic patients undergoing major abdominal surgery. This study evaluated the prognostic value of BT, serum endotoxin, and zonula occludens-1 (ZO-1) for postoperative infections in patients with colon cancer undergoing open or laparoscopic colectomy.
Patients And Methods:
Seventy-one patients (40 open, 31 laparoscopic colectomy) were analyzed. Mesenteric lymph nodes (MLNs) and liver tissue were cultured for BT detection. Serum endotoxin and ZO-1 were measured preoperatively and 24 h post-operation and compared with 12 healthy controls. Postoperative infections and hospital length of stay (HLOS) were recorded.
Results:
Postoperative infection rates did not differ between groups (p=0.16); however, open surgery patients had longer HLOS (p<0.001). BT rates were similar between groups. Endotoxin levels increased on Day 1 in both open (p=0.03) and laparoscopic (p=0.04) groups vs. controls. Serum ZO-1 was significantly higher preoperatively (p<0.001) and remained elevated postoperatively, with no group differences. BT was the only independent risk factor for infection [OR 95% confidence interval (CI)=17.45 (2.65-36.8), p=0.01], while endotoxin and ZO-1 showed low prognostic accuracy. Open surgery and infections were independent predictors of prolonged HLOS (p<0.001).
Conclusion:
Open and laparoscopic colectomy show similar infection rates. Serum ZO-1 and endotoxin are not reliable infection predictors. BT, detected via MLN and liver cultures, is an independent infection risk factor and may aid in identifying high-risk patients for enhanced postoperative surveillance and early intervention.
