The Association Between Intraoperative Compromised Intestinal Integrity and Postoperative Complications in Cancer Patients

• Published in: Annals of surgical oncology Vol. 31; no. 4; pp. 2699 - 2708
• Main Authors: Hendriks, Sharon, Huisman, Monique G., Stokmans, Suzanne C., Plas, Matthijs, van der Wal-Huisman, Hanneke, van Munster, Barbara C., Absalom, Anthony R., Nieuwenhuijs-Moeke, Gertrude J., de Bock, Geertruida H., van Leeuwen, Barbara L., de Haan, Jacco J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2024; Springer Nature B.V
• Subjects: Age; Anesthesia; Blood pressure; Cancer therapies; Cohort analysis; Complications; Data collection; Enterocytes; Fatty acid-binding protein; Fatty acids; Gastrointestinal Oncology; Hypotension; Intestine; Medicine; Medicine & Public Health; Oncology; Patients; Postoperative; Proteins; Sepsis; Small intestine; Surgery; Surgical anastomosis; Surgical Oncology; Trauma; Tumors; Urine; Wound healing
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-14857-7

Background Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied. Methods Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications. Results A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0–142.0) to 115 pg/mL at T1 (IQR 48.0–198.0) ( p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08) and anesthesia time (OR 1.13, 95% CI 1.02–1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86–260) versus 113% (IQR 44–184) respectively ( p < 0.05). Conclusions A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.