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Article Dans Une Revue Journal of Critical Care Année : 2016

Postoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality

Djamel Mokart
  • Fonction : Auteur
Emmanuelle Giaoui
  • Fonction : Auteur
Louise Barbier
  • Fonction : Auteur
Laurent Chow-Chine
  • Fonction : Auteur
Jerome Guiramand
  • Fonction : Auteur
Jacques Ewald
  • Fonction : Auteur
Magali Bisbal
  • Fonction : Auteur
Jean-Louis Blache
  • Fonction : Auteur
Jean-Robert Delpero

Résumé

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.
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Dates et versions

hal-01459792 , version 1 (07-02-2017)

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Citer

Djamel Mokart, Emmanuelle Giaoui, Louise Barbier, Jérôme Lambert, Antoine Sannini, et al.. Postoperative sepsis in cancer patients undergoing major elective digestive surgery is associated with increased long-term mortality. Journal of Critical Care, 2016, 31 (1), pp.48-53. ⟨10.1016/j.jcrc.2015.10.001⟩. ⟨hal-01459792⟩

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