Surgical site infection after laparoscopic resection of colorectal cancer is associated with compromised long-term oncological outcome

Abstract

Background We evaluated the influence of infectious complications, particularly surgical site infection (SSI), on long-term oncological results after elective laparoscopic resection of colorectal cancer. Methods A total of 199 patients who underwent laparoscopic elective resection with negative resection margins for stage I–III colorectal cancer were retrospectively examined. The postoperative course was recorded based on hospital records, and cancer relapse was diagnosed based on radiological or pathological findings under a standardized follow-up program. The severity of complications was graded using Clavien-Dindo (CD) classification. Results SSI was found in 25 patients (12.6%), with 12 (6.0%) showing anastomotic leak. The postoperative relapse-free survival (RFS) rate was significantly lower in patients with SSI (49.2%) than in patients without SSI (87.2%, P<0.001). Differences in RFS were found after both colectomy and rectal resection (P<0.001 and P<0.001, respectively). RFS did not differ between patients who had major SSI CD (grade III) and those who had minor SSI CD (grades I or II). Multivariate Cox regression analysis identified the occurrence of SSI and pathological stage as independent co-factors for RFS (P<0.001 and P=0.003). Conclusion These results suggest that postoperative SSI compromises long-term oncological results after laparoscopic colorectal resection. Further improvements in surgical technique and refinements in perioperative care may improve long-term oncological results.

Effects of wound infection on prognosis after laparoscopic abdominoperineal resection of rectal cancer

“…After CRC surgery, SSI can decrease the DFS after radical surgery ( 6 , 7 ) but has not been demonstrated to be associated with OS. Anastomotic leakage after rectal surgery promotes local recurrence and decreases DFS and OS according to several studies ( 18 – 22 ).…”

“…SSI leads to long postoperative hospital stays and increases the use of postoperative antibiotics, reoperation rate, and psychological stress in patients; in addition, SSI can lead to increased health care costs (3)(4)(5). Moreover, SSI decreases disease-free survival (DFS) and overall survival (OS) (6,7). Rectal anastomotic leakage has been linked to a higher risk of tumor recurrence and shorter OS according to a meta-analysis (8).…”

Traditional Chinese medicine as a novel therapy for colorectal cancer by modulating intestinal flora

“…Common clinical complications of laparoscopic surgery for colorectal cancer include incision infection, fever, urinary tract infection, abdominal infection, intestinal obstruction, anastomotic leakage, etc. These complications adversely affect postoperative recovery of the patients and lead to poor prognosis [6].…”

Incidence of surgical site infection in minimally invasive colorectal surgery

“…According to relevant studies, patients undergoing colorectal surgery are particularly at risk of SSI, with the infection rate as high as 26%[ 4 , 5 ]. Therefore, SSI is one of the most common early complications after colorectal surgery, which often leads to an increase in costs and hospitalization and even affects oncologic outcomes[ 6 - 8 ].…”