The Impact of Surgical Complications on Cancer Recurrence Rates: A Literature Review

Beecher, Suzanne M.; O’Leary, Donal Peter; McLaughlin, R.; Kerin, Michael J.

doi:10.1159/000487510

Cited by 30 publications

(56 citation statements)

References 44 publications

(47 reference statements)

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“…On deeper analysis, including qualitative evaluation using the MINORS criteria, it was found that many of these papers lacked a definition of either SSI or anastomotic leakage 60,61 and, most importantly, no relationship between adverse events and oncological outcome was reported. In contrast, it is increasingly being recognized in other fields of oncology, such as breast cancer, that there may be a relationship between infection and cancer recurrence 76 . Surprisingly SSI data have not been included in cancer registries.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

et al. 2020

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Background: Cancer outcomes are complex, involving prevention, early detection and optimal multidisciplinary care. Postoperative infection and surgical site-infection (SSI) are not only uncomfortable for patients and costly, but may also be associated with poor oncological outcomes. A meta-analysis was undertaken to assess the oncological effects of SSI in patients with colorectal cancer. Methods: An ethically approved PROSPERO-registered meta-analysis was conducted following PRISMA guidelines. PubMed and Scopus databases were searched for studies published between 2007 and 2017 reporting the effects of postoperative infective complications on oncological survival in colorectal cancer. Results were separated into those for SSI and those concerning anastomotic leakage. Articles with a Methodological Index for Non-Randomized Studies score of at least 18 were included. Hazard ratios (HRs) with 95 per cent confidence intervals were computed for risk factors using an observed to expected and variance fixed-effect model. Results: Of 5027 articles were reviewed, 43 met the inclusion criteria, with a total of 154 981 patients. Infective complications had significant negative effects on overall survival (HR 1⋅37, 95 per cent c.i. 1⋅28 to 1⋅46) and cancer-specific survival (HR 2⋅58, 2⋅15 to 3⋅10). Anastomotic leakage occurred in 7⋅4 per cent and had a significant negative impact on disease-free survival (HR 1⋅14, 1⋅09 to 1⋅20), overall survival (HR 1⋅34, 1⋅28 to 1⋅39), cancer-specific survival (HR 1⋅43, 1⋅31 to 1⋅55), local recurrence (HR 1⋅18, 1⋅06 to 1⋅32) and overall recurrence (HR 1⋅46, 1⋅27 to 1⋅68). Conclusion: This meta-analysis identified a significant negative impact of postoperative infective complications on overall and cancer-specific survival in patients undergoing colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

et al. 2020

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“…1 Presurgical parameters. 2 Anaemia: defined as haemoglobin <11.4 g/dL in females and <13 g/dL in males. 3 Hypoalbuminemia: defined as albumin <3.5 g/dL.…”

Section: Cohort Studymentioning

confidence: 99%

“…Therefore, microvascular reconstruction, as a complex surgical procedure performed in patients often with multiple comorbidities—as in oncological patients—can induce serious postoperative complications. The most frequent ones are healthcare-associated infections (HAIs) [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study

Ramos-Zayas

López‐Medrano

Urquiza-Fornovi

et al. 2021

Cancers

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(1) Background: Healthcare-associated infections (HAIs) after head and neck free-flap reconstruction are a common postoperative complication. Risk factors for HAIs in this context and their consequences have not been adequately described. (2) Methods: Ongoing prospective multicentre study between 02/2019 and 12/2020. Demographic characteristics and outcomes were analysed, focusing on infections. (3) Results: Forty out of 65 patients (61.54%) suffered HAIs (surgical site infection: 52.18%, nosocomial pneumonia: 23.20%, bloodstream infection: 13% and urinary tract infection: 5.80%). Methicillin-resistant Staphylococcus aureus (MRSA) and resistant Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae were the most frequently implicated. The significant risk factors for infection were: previous radiotherapy (Odds ratio (OR): 5.42; 95% confidence interval (CI), 1.39–21.10), anaemia (OR: 8.00; 95% CI, 0.96–66.95), salvage surgery (eight out of eight patients), tracheostomy (OR: 2.86; 95% CI, 1.01–8.14), surgery duration (OR: 1.01; 95% CI, 1.00–1.02), microvascular reoperation <72 h (eight/eight) and flap loss (eight/eight). The major surgical complications were: a need to reoperate (OR: 6.89; 95% CI, 1.42–33.51), prolonged hospital admission (OR: 1.16; 95% CI, 1.06–1.27) and delay in the initiation of postoperative radiotherapy (OR: 9.07; 95% CI, 1.72–47.67). The sixth month mortality rate in patients with HAIs was 7.69% vs. 0% in patients without HAIs (p = 0.50). (4) Conclusions: HAIs were common after this type of surgery, many of them caused by resistant microorganisms. Some modifiable risk factors were identified. Infections played a role in cancer prognosis by delaying adjuvant therapy.

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“…When combined, these interventions form a bundle. Wound bundles have been shown to exert significant improvements in outcomes in elective surgery [7,10,11]. Reducing SSIs requires a team approach, involving all providers, in every phase of care, with a cumulative additive benefit of each aspect in the bundle.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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The Impact of Surgical Complications on Cancer Recurrence Rates: A Literature Review

Cited by 30 publications

References 44 publications

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

The Impact of Healthcare-Associated Infections in Patients Undergoing Oncological Microvascular Head and Neck Reconstruction: A Prospective Multicentre Study

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

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