Postoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality
| Autor: | Emmanuelle Giaoui, Louise Barbier, J.P. Brun, J.-L. Blache, Jérôme Guiramand, Jérôme Lambert, Jacques Ewald, Jean-Robert Delpero, Laurent Chow-Chine, Marion Faucher, Olivier Turrini, Antoine Sannini, Magali Bisbal, Djamel Mokart, Marc Leone |
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| Přispěvatelé: | Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Unité Mixte de Recherches sur les Herbivores - UMR 1213 (UMRH), VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique (INRA), Laboratoire de Physiopathologie Respiratoire, Université de la Méditerranée - Aix-Marseille 2, Department of Surgical Oncology, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes (URMITE), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR48, INSB-INSB-Centre National de la Recherche Scientifique (CNRS), Institut des sciences biologiques (INSB-CNRS)-Institut des sciences biologiques (INSB-CNRS)-Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherches sur les Herbivores ( UMR 1213 Herbivores ), VetAgro Sup ( VAS ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Institut National de la Recherche Agronomique ( INRA ), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes ( URMITE ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -IFR48, INSB-INSB-Centre National de la Recherche Scientifique ( CNRS ) |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Esophageal Neoplasms 030230 surgery Critical Care and Intensive Care Medicine law.invention Cholangiocarcinoma 0302 clinical medicine Postoperative Complications law Risk Factors [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases Neoplasms Longitudinal Studies Prospective Studies Simplified Acute Physiology Score Prospective cohort study Middle Aged Intensive care unit 3. Good health [ SDV.MHEP.MI ] Life Sciences [q-bio]/Human health and pathology/Infectious diseases Intensive Care Units Neuroendocrine Tumors Elective Surgical Procedures 030220 oncology & carcinogenesis Female Elective Surgical Procedure Respiratory Insufficiency Carcinoma Pancreatic Ductal medicine.medical_specialty Adenocarcinoma Sepsis 03 medical and health sciences Pancreatectomy Gastrectomy Stomach Neoplasms medicine Humans Mortality Aged Proportional Hazards Models business.industry Postoperative complication Perioperative medicine.disease Surgery Systemic inflammatory response syndrome Esophagectomy Pancreatic Neoplasms Logistic Models business |
| Zdroj: | Journal of Critical Care Journal of Critical Care, WB Saunders, 2016, 31 (1), pp.48-53. ⟨10.1016/j.jcrc.2015.10.001⟩ Journal of Critical Care, 2016, 31 (1), pp.48-53. ⟨10.1016/j.jcrc.2015.10.001⟩ Journal of Critical Care, WB Saunders, 2016, 31 (1), pp.48-53. 〈10.1016/j.jcrc.2015.10.001〉 |
| ISSN: | 0883-9441 |
| Popis: | International audience; Background: Major postoperative events (acute respiratory failure, sepsis, and surgical complications) are frequent early after elective gastroesophageal and pancreatic surgery. It is unclearwhether these complications impact equally on long-term outcome. Methods: Prospective observational study including the patients admitted to the surgical intensive care unit between January 2009 and October 2011 after elective gastroesophageal and pancreatic surgery. Risk factors for 30-day major postoperative events and long-term outcome were evaluated. Results: During the study period, 259 patients were consecutively included. Among them, 166 (64%), 54 (21%), and 39 (15%) patients underwent pancreatic surgery, gastric surgery, and esophageal surgery, respectively. Using the Clavien-Dindo classification, 117 patients (45%) developed at least 1 postoperative complication, including 60 (23%) patients with acute respiratory failure, 77 (30%) with sepsis, and 89 (34%) with surgical complications. Themedian followup from the time of intensive care unit admission was 34months (95% confidence interval, 30-37 months). The 1-year survival was 95% (95% confidence interval, 92-98). Among the perioperative variables, postoperative sepsis and an American Society of Anesthesiologists score higher than 2 were independently associated with long-term mortality. In septic patients, death (n=16) was significantly associated with cancer recurrence (n=10; P < .0001). Independent factors associated with postoperative sepsis were a Sequential Organ Failure Assessment score on day 1, a systemic inflammatory response syndrome on day 3, positive intraoperativemicrobiological samples, Simplified Acute Physiology Score II and an American Society of Anesthesiologists score higher than 2 (P < .005). Conclusions: Postoperative sepsis was the only major postoperative event associated with long-termmortality. Postoperative sepsis may reflect a deep impairment of immune response, which is potentially associated with cancer recurrence and mortality. (C) 2015 Elsevier Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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