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Peroperative endotoxin concentrations in portal and peripheral venous blood in patients undergoing right hemicolectomy for carcinoma.

OBJECTIVE
To find out the incidence of systemic and portal endotoxaemia in a homogeneous group of patients with colonic cancer undergoing a standard operation, and to compare them with a control group with benign disease.


DESIGN
Open study.


SETTING
Department of Surgery, Stockholm Söderhospital.


SUBJECTS
15 of 17 consecutive patients admitted for right hemicolectomy for cancer, and four control subjects (one with angiodysplasia, and three with ulcerative colitis) who were to undergo right hemicolectomy and proctocolectomy.


INTERVENTION
After mobilisation of the colon, 10 ml samples of blood were taken simultaneously from a mesocolic vein, and from an antecubital vein, for assay of endotoxin.


RESULTS
Raised concentrations of endotoxin were found in the portal blood of 4 of the 15 patients with cancer, and in two of the four with benign disease. One of the four with cancer also had a raised value in peripheral blood. There was no correlation between increased endotoxin concentration and tumour size, Dukes' stage, or development of infective complications.


CONCLUSION
Pronounced concentrations of endotoxin are found only rarely in patients undergoing right hemicolectomy for cancer. The most likely explanation is translocation of endotoxin through mucosa damaged by an ulcerating tumour.