Published in Cancer Detection and Prevention 2000; 24(Supplement 1).

Clinical relevance of antibiotic-induced endotoxin release in patients undergoing abdominal major surgeries

M Ishikawa PhD, T Miyauchi PhD, K Yagi PhD, H Chikaishi MD, Y Fukuda PhD, H Miyake PhD, M Harada PhD, M Nishi PhD, S Yogita PhD, S Tashiro PhD

1st Dept Surgery, University of Tokushima, School of Medicine, Tokushima, Japan,

AIMS: It has been proved that antibiotics binding to penicillin-binding protein 3(PBP3) are associated with the greater release of endotoxin than those that bind to PBP2 in both in vitro and animal models. The aim of this study is to evaluate the potential clinical implications of antibiotic-induced endotoxin release after hepatic resection or gastrectomy. METHODS: Forty-five patients who underwent hepatic resection and ten patients who underwent gastrectomy in our clinic were enrolled. The patients were divided into four groups. Group A (n=26); hepatic resection with antibiotics that bind primarily to PBP3. Group B (n=19); hepatic resection with antibiotics that bind to both PBP2 and PBP3. Group C (n=5); gastrectomy with antibiotics that bind primarily to PBP3. Group D (n= 5); gastrectomy with antibiotics that bind to both PBP2 and PBP3. Postoperative complications, liver functional tests and chemical mediators (endotoxin, IL-6, IL-8, TNF-alpha, HGF) were examined after surgeries. There were no significant differences in background of the group A and B or C and D. RESULTS: Each eight patients in group A and B developed postoperative complications; in particular, 9 of 13 patients with biliary tract carcinoma developed postoperative complications. No significant elevation of peripheral blood endotoxin was noted by endoscopy method in all patients although six patients died following sepsis. Pre-and post levels of cytokines showed no significant difference between the group A and B. This trend was seen in group C and D. (CONCLUSIONS) Our data suggest that clinical antibiotic-induced endotoxin release would not occur after hepatic resection or gastrectomy regardless of a variety of antibiotics, probably owing to continuous scavenging of endotoxin from peripheral blood.

KEY WORDS: antibiotics, endotoxin release, operation.

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Paper presented at the International Symposium on Impact of Biotechnology on Cancer Diagnostic & Prognostic Indicators; Geneva, Switzerland; October 28 - 31, 2000; in the section on genetic risk assessment.