Lack of correlation between failure of gut barrier function and septic complications after major upper gastrointestinal surgery

Objective To determine the influence of abnormal gut barrier function on the risk of septic complications in patients undergoing major resectional surgery for u pper gastrointestinal cancer. Summary Background Data A failure of the gut mucosal barrier to exclude bacteria and endotoxin from the portal and systemic circulation is incriminated in the development of sepsis and multiple organ failure. Although the experimental data is compel ling, corroborative evidence from studies in humans is sparse. This study a ttempted to correlate both preoperative gut barrier dysfunction and the pat tern of change after surgery with septic outcome. Methods Sixty-eight patients undergoing curative resectional surgery for upper gast rointestinal cancer were monitored for 30-day septic morbidity (intraabdomi nal abscesses/empyema and pneumonia). Intestinal permeability, serum IgM an d IgG antiendotoxin antibodies (EndoCAb), and serum C-reactive protein were measured before surgery and on postoperative days 1 and 7. Results Increased intestinal permeability before surgery did not predict septic out come. Major surgery was associated with increased intestinal permeability a nd evidence of endotoxin exposure, Comparing sepsis and nonsepsis groups, h owever, there was no significant difference in intestinal permeability, end otoxin exposure, and the acute phase response after surgery. Conclusions This study demonstrates that gut barrier dysfunction occurs after surgery, but the magnitude of change does not differentiate patients in whom sepsis develops and those in whom it does not. Preoperative increased intestinal p ermeability had no predictive value for sepsis. This study failed to suppor t the thesis that gut barrier dysfunction is directly linked to sepsis.