The influence of neoadjuvant chemotherapy on gastric cancer patients’ postoperative infectious complications: What is the negative role played by the intestinal barrier dysfunction?

Abstract

Evidence has shown that neoadjuvant chemotherapy (NACT) is correlated with patients’ overall postoperative complications. But investigations on relationship between NACT and postoperative infectious complications, which is closely linked to intestinal barrier damage, were scanty. Accordingly, 90 patients with advanced gastric cancer were included in this study. The differences in postoperative infectious complications were determined between NACT group in which patients received NACT before surgery and SURG group in which received surgical treatment immediately after diagnosis. The damage of mechanical structure of intestinal barrier was assessed by hematoxylin and eosin staining, transmission electron microscopy, and immunohistochemistry. Mucosal microbiota changes were determined by using a 16S rRNA gene sequencing approach. Results showed that the incidence of postoperative infectious complications were significantly higher in the NACT group. Tight junctions were disrupted, and claudin-1, ZO-1 and occludin were down-regulated in patients with infectious complications in overall compared with those without. And similarly, the patients in the NACT group also showed damaged intestinal barrier compared with those in SURG group. Besides, the total diversity of mucosal related bacteria was decreased and relative abundance of some probiotics, such as Bifidobacterium, Faecalibacterium and Ruminococcus, was reduced in the NACT group as well. In conclusion, our study identifies a higher incidence of postoperative infection in gastric cancer patients who underwent NACT treatment, and these changes might be caused by a significant damage in the intestinal barrier as well as reduced probiotics.

Short-term outcomes of laparoscopic versus open total gastrectomy after neoadjuvant chemotherapy: a cohort study using the propensity score matching method

“…There is still debate as to whether NACT increases postoperative morbidity and mortality (38,48,49). In the current study, morbidity rates were 34.78% both in LTG and OTG groups, including the incidence of infection with 23.19% for all-cause and 13.04% for intra-abdomen.…”

“…Further, this more sophisticated technique requires a longer duration of nursing care and hospital stay. There are still concerns about the damage to the intestinal barrier and reduced probiotics due to NACT (37,38). The NACT, on the other hand, might affect the outcomes of the procedure in varying degrees according to the type of resection.…”

The Association of Gut Microbiota and Complications in Gastrointestinal-Cancer Therapies

“…In patients with advanced gastric cancer, patients who had received neoadjuvant chemotherapy before surgery also had increased postoperative infections. Lower diversity and reduced Bifidobacterium, Faecalibacterium, and Ruminococcus in patients with postoperative infections were detected [43]. The next step is to modify the effects of Fusobacterium nucleatum to improve patient outcomes.…”

Short-Term Clinical Efficacy of Neoadjuvant Chemotherapy Combined With Laparoscopic Gastrectomy for Locally Advanced Siewert Type II and III Adenocarcinoma of the Esophagogastric Junction: A Retrospective, Propensity Score-Matched Study

“…In their stratified analysis of 92 patients after PSM, Amir et al (32) found that the NACT group had similar postoperative complications with the surgery alone group. However, in a study of 90 patients, Wei et al (33) revealed that the NACT group had a higher risk of postoperative infectious complications. Possible explanations for the differences may be that the baselines of the two studies were inconsistent.…”

“…However, in a study of 90 patients, Wei et al. ( 33 ) revealed that the NACT group had a higher risk of postoperative infectious complications. Possible explanations for the differences may be that the baselines of the two studies were inconsistent.…”