Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial): Selective decontamination of the digestive tract in colorectal cancer surgery

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Abstract

Infectious complications and anastomotic leakage affect approximately 30 per cent of patients after colorectal cancer surgery. The aim of this multicentre randomized trial was to investigate whether selective decontamination of the digestive tract (SDD) reduces these complications of elective colorectal cancer surgery.

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Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak.

Benjamin D Shogan, Natalia Belogortseva, Preston M Luong … (2015)

Even under the most expert care, a properly constructed intestinal anastomosis can fail to heal, resulting in leakage of its contents, peritonitis, and sepsis. The cause of anastomotic leak remains unknown, and its incidence has not changed in decades. We demonstrate that the commensal bacterium Enterococcus faecalis contributes to the pathogenesis of anastomotic leak through its capacity to degrade collagen and to activate tissue matrix metalloproteinase 9 (MMP9) in host intestinal tissues. We demonstrate in rats that leaking anastomotic tissues were colonized by E. faecalis strains that showed an increased collagen-degrading activity and also an increased ability to activate host MMP9, both of which contributed to anastomotic leakage. We demonstrate that the E. faecalis genes gelE and sprE were required for E. faecalis-mediated MMP9 activation. Either elimination of E. faecalis strains through direct topical antibiotics applied to rat intestinal tissues or pharmacological suppression of intestinal MMP9 activation prevented anastomotic leak in rats. In contrast, the standard recommended intravenous antibiotics used in patients undergoing colorectal surgery did not eliminate E. faecalis at anastomotic tissues nor did they prevent leak in our rat model. Finally, we show in humans undergoing colon surgery and treated with the standard recommended intravenous antibiotics that their anastomotic tissues still contained E. faecalis and other bacterial strains with collagen-degrading/MMP9-activating activity. We suggest that intestinal microbes with the capacity to produce collagenases and to activate host metalloproteinase MMP9 may break down collagen in the intestinal tissue contributing to anastomotic leak.

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Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer.

C S McArdle, D McMillan, D Hole (2005)

The impact of anastomotic leakage on immediate postoperative mortality in patients undergoing potentially curative resection for colorectal cancer is well recognized. Its impact on long-term survival is less clear. The aim of the present study was to evaluate the relationship between anastomotic leakage and long-term survival in patients undergoing potentially curative resection for colorectal cancer. A total of 2235 patients who underwent potentially curative resection for colorectal cancer between 1991 and 1994 in Scotland were included in the study. Five-year survival rates and adjusted hazard ratios were calculated. Fourteen (16 per cent) of the 86 patients with an anastomotic leak died within 30 days of surgery compared with 83 (3.9 per cent) of 2149 without a leak. The 5-year cancer-specific survival rate, including postoperative deaths, was 42 per cent in patients with an anastomotic leak compared with 66.9 per cent in those with no leak (P < 0.001). Excluding postoperative deaths, respective values were 50 and 68.0 per cent (P < 0.001). The adjusted relative hazard ratios, for patients with an anastomotic leak compared with those without a leak, and excluding 30-day mortality, were 1.61 (95 per cent confidence interval (c.i.) 1.19 to 2.16; P = 0.002) for overall survival and 1.99 (95 per cent c.i. 1.42 to 2.79; P < 0.001) for cancer-specific survival. Development of an anastomotic leak is associated with worse long-term survival after potentially curative resection for colorectal cancer. Copyright 2005 British Journal of Surgery Society Ltd.

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Rectal Swabs for Analysis of the Intestinal Microbiota

Andries Budding, Matthijs Grasman, Anat Eck … (2014)

The composition of the gut microbiota is associated with various disease states, most notably inflammatory bowel disease, obesity and malnutrition. This underlines that analysis of intestinal microbiota is potentially an interesting target for clinical diagnostics. Currently, the most commonly used sample types are feces and mucosal biopsy specimens. Because sampling method, storage and processing of samples impact microbiota analysis, each sample type has its own limitations. An ideal sample type for use in routine diagnostics should be easy to obtain in a standardized fashion without perturbation of the microbiota. Rectal swabs may satisfy these criteria, but little is known about microbiota analysis on these sample types. In this study we investigated the characteristics and applicability of rectal swabs for gut microbiota profiling in a clinical routine setting in patients presenting with various gastro-intestinal disorders. We found that rectal swabs appeared to be a convenient means of sampling the human gut microbiota. Swabs can be performed on demand, whenever a patient presents; swab-derived microbiota profiles are reproducible, whether they are gathered at home by patients or by medical professionals in an outpatient setting and may be ideally suited for clinical diagnostics and large-scale studies.

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Author and article information

Journal

Title: British Journal of Surgery

Abbreviated Title: Br J Surg

Publisher: Wiley

ISSN: 00071323

Publication date Created: March 2019

Publication date (Print): March 2019

Publication date (Electronic): February 25 2019

Volume: 106

Issue: 4

Pages: 355-363

Affiliations

[1 ]Department of Surgery, VU University Medical Centre, Amsterdam, the Netherlands

[2 ]Department of Surgery, Spaarne Gasthuis, Haarlem/Hoofddorp, the Netherlands

[3 ]Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, the Netherlands

[4 ]Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands

Article

DOI: 10.1002/bjs.11117

PubMed ID: 30802304

SO-VID: c3c4751c-1508-4055-b6b5-967451c732f7

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Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial) : Selective decontamination of the digestive tract in colorectal cancer surgery

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Most cited references 19

Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak.

Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer.

Rectal Swabs for Analysis of the Intestinal Microbiota

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