Prognostic Role of Bacterial Translocation, Serum Endotoxin, and ZO-1 in Postoperative Infections Following Colorectal Cancer Surgery

Abstract

Background/aim: Bacterial translocation (BT) is linked to increased postoperative infections in oncologic patients undergoing major abdominal surgery. This study evaluated the prognostic value of BT, serum endotoxin, and zonula occludens-1 (ZO-1) for postoperative infections in patients with colon cancer undergoing open or laparoscopic colectomy.

Patients and methods: Seventy-one patients (40 open, 31 laparoscopic colectomy) were analyzed. Mesenteric lymph nodes (MLNs) and liver tissue were cultured for BT detection. Serum endotoxin and ZO-1 were measured preoperatively and 24 h post-operation and compared with 12 healthy controls. Postoperative infections and hospital length of stay (HLOS) were recorded.

Results: Postoperative infection rates did not differ between groups (p=0.16); however, open surgery patients had longer HLOS (p<0.001). BT rates were similar between groups. Endotoxin levels increased on Day 1 in both open (p=0.03) and laparoscopic (p=0.04) groups vs. controls. Serum ZO-1 was significantly higher preoperatively (p<0.001) and remained elevated postoperatively, with no group differences. BT was the only independent risk factor for infection [OR 95% confidence interval (CI)=17.45 (2.65-36.8), p=0.01], while endotoxin and ZO-1 showed low prognostic accuracy. Open surgery and infections were independent predictors of prolonged HLOS (p<0.001).

Conclusion: Open and laparoscopic colectomy show similar infection rates. Serum ZO-1 and endotoxin are not reliable infection predictors. BT, detected via MLN and liver cultures, is an independent infection risk factor and may aid in identifying high-risk patients for enhanced postoperative surveillance and early intervention.

Keywords: Colorectal cancer; ZO-1; bacterial translocation; colectomy; endotoxin; postoperative infections.