Bacterial translocation may influence the long-term survival in colorectal cancer patients.
OBJECTIVE
The purpose of this study was to investigate the association of bacterial translocation with long-term disease-specific and disease-free survival in colorectal cancer patients.


METHODS
This was a prospective cohort study in which 128 and 30 colorectal cancer patients undergoing curative and palliative resections, respectively, were recruited between 1992 and 1997. Samples of mesenteric lymph nodes were harvested for culture before administration of prophylactic antibiotics. Median follow-up for patients without cancer death was 103 (range, 72-147) months. This cohort of patients was internally validated by Dukes staging.


RESULTS
The cumulative disease-specific survival (time to death) and disease-free survival (time to recurrence) for all patients at five years of follow-up was 55 percent (standard error [SE], 4.4 percent) and 65 percent (SE, 4.8 percent), respectively. Bacteria were isolated from the mesenteric nodes of 23 (15 percent) patients. There was no association between bacterial translocation and nodal metastases, bowel obstruction, and septic complications. Patients with confirmed bacterial translocation had a worse disease-specific survival (n=158, 5-year survivorship estimates+/-SE, 38 percent+/-12 percent vs. 58 percent+/-4.7 percent; P < 0.01) and disease-free survival (n=128, 5-year survivorship estimates+/-SE, 46 percent+/-14 percent vs. 66 percent+/-5 percent; P = 0.004) than those without. Using multivariate Cox regression analysis, bacterial translocation was a predictor of disease-specific survival (P = 0.011) and disease-free survival (P = 0.02) independent of other pathologic prognostic indicators.


CONCLUSIONS
Colorectal cancer patients with bacterial translocation in the mesenteric lymph nodes have a worse outcome.
Chin
Kin F
KF
Department of General Surgery, Combined Gastroenterology Unit, Scarborough Hospital, Scarborough, North Yorkshire, United Kingdom.
Kallam
R
R
O'Boyle
Colm
C
MacFie
John
J
D018988:Bacterial Translocation; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000401:mortality*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000382:microbiology; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis