title: 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.
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Zhiliang
authors.initials: Z
authors.lastname: Wei
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Shougen
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Shanglong
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Xiaojie
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of General Surgery, Yantai Yuhuangding Hospital, Yantai, China.
authors.forename: Zengwu
authors.initials: Z
authors.lastname: Yao
authors.affiliation: Department of Histology and Embryology, Binzhou Medical University, Yantai, China.
authors.forename: Na
authors.initials: N
authors.lastname: Yin
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Jiante
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Epidemiology and Health Statistics, Qingdao University Medical College, Qingdao, China.
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Yanbing
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007239:Infections / Q000209:etiology*; D007410:Intestinal Diseases / Q000473:pathology; D007413:Intestinal Mucosa / Q000382:microbiology / Q000473:pathology / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology*; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D019108:Tight Junctions / Q000378:metabolism
keywords: gastric cancer; intestinal barrier dysfunction; intestinal microbiology; neoadjuvant chemotherapy; postoperative infectious complications