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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

Nishigaki, Eiji MD*; Abe, Tetsuya MD*; Yokoyama, Yukihiro MD*; Fukaya, Masahide MD*; Asahara, Takashi PhD; Nomoto, Koji PhD; Nagino, Masato MD*

doi: 10.1097/SLA.0b013e31828e39e8
Original Articles

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.

This study was designed to investigate the incidence of bacterial translocation (BT) during an esophagectomy using a bacterium-specific ribosomal RNA-targeted reverse-transcriptase quantitative polymerase chain reaction. Esophagectomy clearly induced intraoperative BT, and the incidence of BT was significantly associated with postoperative infectious complications.

*Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; and

Yakult Central Institute for Microbiological Research, Tokyo, Japan.

Reprints: Masato Nagino, MD, Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. E-mail: nagino@med.nagoya-u.ac.jp.

Disclosure: The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.