We read with great interest the study by Adachi et al. [1] reviewing the risk factors for bacterial translocation (BT) following loop ileostomy closure in patients with colorectal cancer.
The association between adjuvant chemotherapy and BT is particularly noteworthy, as systemic therapy may impair mucosal barrier function and immune response, predisposing patients to bacterial translocation [2]. Similarly, elevated postoperative CRP likely suggests an exaggerated inflammatory response, which is commonly associated with complications after colorectal surgery. Previous studies have identified age, comorbidities, and postoperative complications as predictors of morbidity after ileostomy closure [3], but only a few have discussed association of BT [4].
Bacterial translocation (BT) suggests the passage of bacteria and its products from the intestinal lumen across the mucosal barrier into normally sterile tissues. the bacteria can migrate from the gut to the systemic circulation and eventually to distant organs via the lymphatic and vascular routes [5, 6].
We believe that several important factors were not fully considered which may affect the drawn conclusions. In particular, the study does not discuss the timing of ileostomy closure in relation to adjuvant chemotherapy or the specific chemotherapy regimens used. Additionally, operative duration, nutritional status, and perioperative antibiotic use were not considered as they both can affect the intestinal mucosal barrier and may have impacted the final incidence of bacterial translocation following ileostomy closure [7]. These parameters should be considered for meaningful conclusions. We congratulate the authors for their commendable work and hope that this study will encourage further studies with larger cohort into this important topic, ultimately contributing to improved outcomes in surgical patients.
Author contributions
Contributor 1 (RA) – editing of the manuscript, analysis, data collection Contributor 2 (MB)—Designed the research and performed the statistical analysis, manuscript formation, editing of the manuscript.
Funding
None.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Prior publication
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Conflict of interest
The authors declare no competing interests.
Footnotes
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References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.