Impact of preoperative fecal short chain fatty acids on postoperative infectious complications in esophageal cancer patients

Hiroshi Miyata,Masaaki Motoori,Takuro Saito,Masahiko Yano,Kazumasa Fujitani,Yasuhiro Miyazaki,Takashi Asahara,Yukiko Kado,Keijiro Sugimura,Koji Tanaka

doi:10.1186/s12876-020-01217-y

Abstract

BackgroundThe intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer.MethodsFifty-five patients with esophageal cancer who underwent esophagectomy were enrolled in this study. Perioperative synbiotics were administered to all patients. Perioperative clinical characteristics and concentrations of preoperative fecal organic acids were compared between patients with and without postoperative infectious complications.ResultsPostoperative infectious complications occurred in 10 patients. In patients with complications, the concentrations of acetic acid and propionic acid were significantly lower than in patients without complications (p = 0.044 and 0.032, respectively). The concentration of butyric acid was nonsignificantly lower in patients with complications, while the concentration of lactic acid was nonsignificantly higher. The calculated gap between the concentrations of fecal acetic acid plus propionic acid plus butyric acid minus lactic acid was significantly lower in patients with complications. Multivariate analysis revealed that a low gap between acetic acid plus propionic acid plus butyric acid minus lactic acid was an independent risk factor for postoperative infectious complications (p = 0.027).ConclusionsPreoperative fecal concentrations of organic acids had a clinically important impact on the occurrence of postoperative infectious complications in patients with esophageal cancer. To reduce postoperative infectious complications, it may be useful to modulate the intestinal environment and maintain concentrations of fecal organic acids before surgery.

Highlights

The intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body
Severe insults have a negative impact on the intestinal environment, which may decrease intestinal barrier function and cause bacterial translocation
We previously reported that esophagectomy in patients with esophageal cancer disturbed the intestinal microbiota and decreased the concentrations of organic acids, while the administration of perioperative synbiotics significantly shortened the duration of the postoperative systemic inflammatory response syndrome and nonsignificantly reduced postoperative infectious complications by maintaining the intestinal microbiota and the concentrations of organic acids [3]

Summary

Introduction

The intestinal epithelial barrier allows absorption of dietary nutrients and prevents passage of pathogens and toxins into the body. Bacterial translocation, which can cause infectious complications, is defined as the passage of microbes from the gastrointestinal tract across the mucosal barrier to extraintestinal sites. The aim of this study was to investigate the correlation between concentrations of preoperative fecal organic acids and the occurrence of postoperative infectious complications in patients with esophageal cancer. Bacterial translocation, which can cause infectious complications, is the passage of microbes or their products from the gastrointestinal tract across the mucosal barrier to extraintestinal sites, such as the mesenteric lymph nodes, liver, or bloodstream. Several investigators demonstrated that severe insults, such as major surgery and the severe systemic inflammatory response syndrome, disrupt the intestinal environment, in particular disturbing the intestinal microbiota and decreasing the concentrations of organic acids [3, 5, 6]. Yokoyama et al reported that low preoperative fecal concentrations of SCFAs were significantly associated with the occurrence of postoperative infectious complications in patients undergoing major hepatectomy with extrahepatic bile duct resection [7]

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