Μελέτη της επίδρασης της βακτηριακής αλλόθεσης στην μετεγχειρητική πορεία και την απώτερη πρόγνωση ασθενών με καρκίνο του παχέος εντέρου

Abstract

Introduction: Bacterial translocation is defined as the passage of live bacteria or theirconstituents from the gastrointestinal tract in extraintestinal sites. The importance ofbacterial translocation in colorectal cancer patients remains controversial. This studyinvestigates the association of bacterial translocation with long-term prognosis ofpatients with colorectal cancer. Additionally this study examines the predictive valueof serum procalcitonin measurement in patients with colorectal cancer.Material and Methods: This prospective study enrolled 54 consecutive patients withhistologically confirmed colorectal cancer. After receipt of patient's consent patientdemographics and clinical and pathological features of the disease were documented.Moreover, the value of serum procalcitonin, WBC, ESR and CRP were measured in ablood sample. In the operating room, immediately after laparotomy and before anysurgical manipulation irrigation of the peritoneal cavity with 100cc N / S 0.9% wasperformed and the washing was collected and sent for culture to determine thepossible presence of bacteria.Postoperatively, patients were followed for 60 days, during which all postoperativecomplications were recorded. Furthermore, long term overall survival and diseasefreesurvival were recorded.All statistical analyzes were performed with the statistical package SPSS. The p-value<0.05 was determined as statistically significant level of difference but we alsorecorded marginally significant statistical differences (0.05 <P <0.1).Results: The study included 32 men and 22 women with a mean age of 71 ± 11.02years . The median duration of hospitalization was 11 days , 35 % had complicationsduring hospitalization and 4% resulted in death. The cultures of the peritoneal lavagefluid was positive in 11% of patients with isolation Gram positive in 67% and Gramnegative pathogenic microorganism in 33%. Statistical analysis revealed no significant correlation between the culture of the peritoneal fluid and patientcharacteristics, clinical course, characteristics of the tumors and the levels of whiteblood cells , ESR , CRP, PCT and CEAThe analysis showed a significant positive correlation between the PCT andinflammatory markers (WBC, CRP, TKE) and the tumor marker CEA (p <0.05).Patients with distant metastases had significantly higher levels of PCT (0.074compared to 0.043 mg / L) compared to patients without metastases (p <0.05).Marginal statistical significance was found between the PCT and the degree ofdifferentiation (p = 0.09) The median follow up was 46 [ 22, 55 ] months . Duringfollow-up of patients 45.5 % had disease recurrence and 43.6 % died.The statistical analysis did not show the presence of significant correlation betweenthe result of the culture of the peritoneal fluid, and the overall and disease-freesurvival. The Kaplan-Meier survival showed a trend towards a shorter overallsurvival in patients with elevated levels of PCT No statistically significant correlationbetween the levels PCT and disease-free survival of patients was foundConclusion: The results of this study showed that bacterial translocation is relativelyfrequent in colorectal cancer and Procalcitonin is a useful biomarker for theinvestigation of patients with colorectal cancer. The clinical significance of bacterialtranslocation in patients with colorectal cancer is minimal as is not correlated withprognosis.