Key result
Oncologic surgery is linked to a ~44% rise in urinary I-FABP, indicating compromised intestinal integrity.
Why the study?
Perioperative splanchnic hypoperfusion compromises gut wall integrity and may contribute to complications, but the occurrence and clinical significance of intraoperative intestinal integrity loss during oncologic surgery needed investigation.
Does intraoperative compromised intestinal integrity, measured by urine I-FABP levels, associate with postoperative complications in patients undergoing oncologic surgery?
Cohort (n=297)
No
Does intraoperative compromised intestinal integrity, measured by urine I-FABP levels, associate with postoperative complications in patients undergoing oncologic surgery?
Absolute Event Rate: 115% vs 80%
p-value: p=<0.05
Intraoperative loss of intestinal integrity, indicated by increased urine I-FABP levels, is associated with a higher risk of 30-day postoperative complications in cancer patients.
I-FABP rise during oncologic surgery was associated with complications; hypothesis-generating and needs prospective validation before clinical adoption.
BACKGROUND: Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied. METHODS: Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications. RESULTS: A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0-142.0) to 115 pg/mL at T1 (IQR 48.0-198.0) (p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08) and anesthesia time (OR 1.13, 95% CI 1.02-1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86-260) versus 113% (IQR 44-184) respectively (p < 0.05). CONCLUSIONS: A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.
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Hendriks et al. (2024) conducted a cohort in Solid tumors requiring oncologic surgery (n=297). Oncologic surgery vs. Preoperative baseline was evaluated on Change in urine I-FABP levels from preoperatively (T0) to wound closure (T1) (p=<0.05). Oncologic surgery significantly increased median urinary I-FABP levels from 80.0 pg/mL preoperatively to 115 pg/mL at wound closure, indicating compromised intestinal integrity.
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