Gut barrier function and systemic endotoxemia after laparotomy or laparoscopic resection for colon cancer: A prospective randomized study

Abstract

PURPOSE:The gut barrier is altered in certain pathologic conditions (shock, trauma, or surgical stress), resulting in bacterial and/or endotoxin translocation from the gut lumen into the systemic circulation. In this prospective randomized study, we investigated the effect of surgery on intestinal permeability (IP) and endotoxemia in patients undergoing elective colectomy for colon cancer by comparing the laparoscopic with the open approach.PATIENTS AND METHODS:A hundred twenty-three consecutive patients underwent colectomy for colon cancer: 61 cases were open resection (OR) and 62 cases were laparoscopic resection (LR). IP was measured preoperatively and at days 1 and 3 after surgery. Serial venous blood sample were taken at 0, 30, 60, 90, 120, and 180 min, and at 12, 24, and 48 h after surgery for endotoxin measurement.RESULTS:IP was significantly increased in the open and closed group at day 1 compared with the preoperative level (P < 0.05), but no difference was found between laparoscopic and open surgery group. The concentration endotoxin systemic increased significantly in the both groups during the course of surgery and returned to baseline levels at the second day. No difference was found between laparoscopic and open surgery. A significant correlation was observed between the maximum systemic endotoxin concentration and IP measured at day 1 in the open group and in the laparoscopic group.CONCLUSION:An increase in IP, and systemic endotoxemia were observed during the open and laparoscopic resection for colon cancer, without significant statistically difference between the two groups.

Effect of Ulinastatin on Early Postoperative Cognitive Dysfunction in Elderly Patients Undergoing Surgery: A Systemic Review and Meta-Analysis

“…Systemic inflammatory response has been proven to be induced by gut microbiome-driving LPS with surgery-induced intestinal barrier dysfunction (Rhee, 2014 ; Schietroma et al, 2016 ). According to a trial that was included in our study, the level of serum LPS showed an association with the incidence of POCD (Zhang et al, 2018 ).…”

“…Moreover, inhibition of systemic inflammatory response during the early postoperative period improves postoperative cognitive function, reducing the incidence of POCD in the elderly (Zhang et al, 2018 ). Alarmins were released from the surgical trauma tissue injury or secreted by stimulated leukocytes and epithelial cells, such as high-mobility histone 1, neutrophils, and monocyte cytoplasmic proteins S100A8 and S100A9, as well as systemic endotoxemia, which in turn activate the inflammatory pathway, leading to the release of pro-inflammatory cytokines and anti-inflammatory cytokines, such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-10, and so on (Chan et al, 2012 ; Schietroma et al, 2013 , 2016 ). After that, the peripheral inflammatory cytokines activate and compromise with the blood–brain barrier (BBB) integrity, allowing increased infiltration of inflammatory factors and macrophages into the brain (Fu et al, 2014 ), ultimately leading to the damage of neurological function (Leslie, 2017 ; Wei et al, 2019 ).…”