Bacterial Translocation: Not a Clinically Relevant Phenomenon in Colorectal Cancer

Abstract

The aim of this study was to identify the risk factors for bacterial translocation and to determine the clinical significance of bacterial translocation in patients with colorectal cancer. Mesenteric lymph node sampling was performed to identify the presence of bacterial translocation in 75 patients with colorectal cancer undergoing laparotomy. Bacterial translocation was identified in 29 patients (39%), with the most common organism being Escherichia coli (31%). Three factors for bacterial translocation were identified, including a preoperative low peripheral lymphocyte count, metastasis to lymph nodes, and invasion depth (= T3). Stepwise regression analysis, however, selected only = T3 [odds ratio (OR) 4.0, 95% confidence interval (CI) 1.2-13.5]. Altogether, 35% of patients with bacterial translocation developed septic complications, compared with 20% in patients without bacterial translocation. In the multivariate analysis, bacterial translocation was not an independent risk factor for infection, with an OR of 1.8 (95% CI 0.56-5.96). Systemic inflammatory response syndrome developed on the first day in 62% of patients with bacterial translocation, compared with 50% of patients without bacterial translocation. Adjusting for the other factors, bacterial translocation was not a significant risk factor in the occurrence of systemic inflammatory response syndrome after surgery (OR 1.1, 95% CI 0.37-3.29). We concluded that in patients with colorectal cancers bacterial translocation does occur and is increased in patients with deep invasion. However, it appears to be of no clinical significance.

Bacterial translocation studied in 927 patients over 13 years

“…BT occurred more frequently in patients who underwent emergency surgery and in those who received preoperative TPN. In contrast to reports published previously by both the authors and other investigators, there was no evidence to suggest an independent association between BT and age 8 , intestinal obstruction 3,11 , obstructive jaundice 6,12 , inflammatory bowel disease 13 or malignancy 14 . The reason for these differences is almost certainly a consequence of the fact that all previous studies based their conclusions exclusively on univariate analysis.…”

The Relation of the Level of Serum Anti-TF, -Tn and -Alpha-Gal IgG to Survival in Gastrointestinal Cancer Patients

“…The increased level of antibodies in benign diseases may be related to bacterial translocation (BT). BT frequently occurs in patients with benign and malignant gastrointestinal diseases 2, 3 and may be one of the reason of an augmented immune response. In colorectal cancer patients, BT in the mesenteric lymph nodes is indicative of a worse outcome 38.…”

“…In different pathologies of the digestive tract, including cancer, the altered colonization and bacterial translocation occurr 1-3 that may change the pattern and level of circulating anti-carbohydrate antibodies. Comparative data about spontaneously occurring anti-carbohydrate antibodies in relation to survival of patients with gastrointestinal cancer are scanty, but may be of clinical significance.…”

An Occurrence of Sepsis During Inpatient Fecal Disimpaction

“…12 Multiple reviews of the literature have concluded that BT occurs in humans, although its clinical significance has been questioned. 11,13-16 BT has been studied or described in humans in many varied clinical scenarios such as laparotomy, 17,18 emergency and elective surgery, [17][18][19][20] hematologic and colorectal malignancies, 21,22 intestinal obstruction, 23,24 burns, 25 inflammatory bowel disease, 26,27 aortic aneurysm repair, 28 liver resection, 29,30 obstructive jaundice, 31,32 trauma, [33][34][35] pediatric small bowel transplant, 36 and surgical neonates and infants receiving PN, 37 among others. Several of these studies also related BT to increased morbidity, [17][18][19]21,[23][24][25][26]28,29,31,33,34,37 but others did not.…”

“…Several of these studies also related BT to increased morbidity, [17][18][19]21,[23][24][25][26]28,29,31,33,34,37 but others did not. 20,22,27,30,32,35,36 A commonly proposed promotional mechanism of BT is physical damage to the barrier function of the intestinal mucosa leading to increased permeability. 13,15,38 A stercoral injury resulting from our patient' s chronic fecal impaction could cause such damage directly, although such injuries are rare and typically seen in elderly, nursing home-dependent, bedridden, or narcotic-dependent patients.…”