Annals of Surgery

Skip Navigation LinksHome > December 2010 - Volume 252 - Issue 6 > Intraoperative Bacterial Translocation Detected by Bacterium...
Annals of Surgery:
doi: 10.1097/SLA.0b013e3181f3f355
Original Articles: ORIGINAL STUDY

Intraoperative Bacterial Translocation Detected by Bacterium-Specific Ribosomal RNA-Targeted Reverse-Transcriptase Polymerase Chain Reaction for the Mesenteric Lymph Node Strongly Predicts Postoperative Infectious Complications After Major Hepatectomy for Biliary Malignancies

Mizuno, Takashi MD*; Yokoyama, Yukihiro MD*; Nishio, Hideki MD*; Ebata, Tomoki MD*; Sugawara, Gen MD*; Asahara, Takashi PhD; Nomoto, Koji PhD; Nagino, Masato MD*

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Background: There is little evidence indicating a causal linkage between bacterial translocation and postoperative infectious complication (POIC) in human studies.

Objective: To investigate the correlation between the occurrence of bacterial translocation in the mesenteric lymph node (MLN) and POIC with a sensitive quantitative method using bacterium-specific ribosomal RNA (rRNA)-targeted reverse transcriptase–polymerase chain reaction (RT-qPCR).

Methods: Patients who underwent major hepatectomy for biliary malignancies involving hepatic hilus were included in this study (n = 65). Mesenteric lymph nodes were harvested from the jejunal mesentery 2 times during the operation (MLN-1 harvested at laparotomy and MLN-2 harvested after tumor resection). Microorganisms were detected by a bacterium-specific rRNA-targeted RT-qPCR method. Perioperative factors and POIC were recorded prospectively.

Results: Of 65 patients, 51 completed the study. Microorganisms were detected in MLN-1 and MLN-2 in 15 (29.4%) and 19 (37.3%) patients, respectively. The detection of microorganisms in MLN-1 was significantly correlated with the incidence of preoperative cholangitis (P = 0.04), whereas the detection of microorganisms in MLN-2 was significantly correlated with the incidence of POIC (P = 0.002). In multivariate analysis, a positive result for detection of microorganisms in MLN-2 was one of the independent predictive factors of POIC (odds ratio = 26.1).

Conclusions: Intraoperative analysis of MLNs (especially MLN-2) by rRNA-targeted RT-qPCR can strongly predict the occurrence of POIC after hepatectomy for biliary malignancy. This method is more sensitive and faster at detection of microorganisms than the conventional culture method. Therefore, we can obtain the information of bacterial translocation immediately after the surgery and can select the group of patients with high risk for POIC.

© 2010 Lippincott Williams & Wilkins, Inc.


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