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Calu V, Piriianu C, Miron A, Grigorean VT. Surgical Site Infections in Colorectal Cancer Surgeries: A Systematic Review and Meta-Analysis of the Impact of Surgical Approach and Associated Risk Factors. Life (Basel) 2024; 14:850. [PMID: 39063604 PMCID: PMC11278392 DOI: 10.3390/life14070850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) represent a noteworthy contributor to both morbidity and mortality in the context of patients who undergo colorectal surgery. Several risk factors have been identified; however, their relative significance remains uncertain. METHODS We conducted a meta-analysis of observational studies from their inception up until 2023 that investigated risk factors for SSIs in colorectal surgery. A random-effects model was used to pool the data and calculate the odds ratio (OR) and 95% confidence interval (CI) for each risk factor. RESULTS Our analysis included 26 studies with a total of 61,426 patients. The pooled results showed that male sex (OR = 1.45), body mass index (BMI) ≥ 25 kg/m2 (OR = 1.09), American Society of Anesthesiologists (ASA) score ≥ 3 (OR = 1.69), were all independent risk factors for SSIs in colorectal surgery. Conversely, laparoscopic surgery (OR = 0.70) was found to be a protective factor. CONCLUSIONS The meta-analysis conducted revealed various risk factors, both modifiable and non-modifiable, associated with surgical site infections (SSIs) in colorectal surgery. These findings emphasize the significance of targeted interventions, including optimizing glycemic control, minimizing blood loss, and using laparoscopic techniques whenever feasible in order to decrease the occurrence of surgical site infections in this particular group of patients.
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Affiliation(s)
- Valentin Calu
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Catalin Piriianu
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Miron
- Elias University Emergency Hospital, 011461 Bucharest, Romania
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Valentin Titus Grigorean
- Department of Surgery, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
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Qu SP, Rao SQ, Hai ZX, Wang CY. Does chronic kidney disease affect the short-term outcomes and prognosis of colorectal cancer surgery? A propensity score matching analysis. Front Oncol 2024; 14:1400313. [PMID: 39022589 PMCID: PMC11251913 DOI: 10.3389/fonc.2024.1400313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The aim of this study was to analyze the effect of chronic kidney disease (CKD) on the short-term outcomes and prognosis of colorectal cancer (CRC) patients who underwent primary surgery. Methods CRC patients who underwent radical surgery were included from Jan 2011 to Jan 2020 in a single hospital. The short-term outcomes and prognosis were compared between the CKD group and the Non-CKD group using propensity score matching (PSM) analysis. Results A total of 4056 patients undergoing CRC surgery were included, including 723 patients in the CKD group and 3333 patients in the Non-CKD group. After 1:1 PSM, there were 666 patients in each group, respectively. No significant difference was found in baseline characteristics between the two groups. (p>0.05). After PSM, the CKD group had a longer postoperative hospital stay (P=0.009) and a higher incidence of overall complications (p=0.050). Cox analysis was performed on matched patients to find predictors of overall survival (OS) and disease-free survival (DFS). We found that age (p<0.01, HR=1.045, 95% CI=1.028-1.062), tumor stage (p<0.01, HR=1.931, 95% CI=1.564-2.385) and overall complications (p<0.01, HR=1.858, 95% CI=1.423-2.425) were independent predictors of OS. Age (p<0.01, HR=1.034, 95% CI=1.020-1.049), tumor stage (p<0.01, HR=1.852, 95% CI=1.537-2.231), and overall complications (p<0.01, HR=1.651, 95% CI=1.295-2.10) were independent predictors of DFS. However, CKD was not an independent predictor of OS or DFS (OS: p=0.619, HR=1.070, 95% CI=0.820-1.396; DFS: p=0.472, HR=1.092, 95% CI=0.859-1.389). Conclusion CKD prolonged postoperative hospital stay; however, CKD might not affect major postoperative complications, OS or DFS of CRC.
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Affiliation(s)
| | | | | | - Chun-Yi Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chen J, Zhao J, Wu H, Wang T, Gao C. Efficacy and safety of oral probiotic supplementation in mitigating postoperative surgical site infections in patients undergoing colorectal cancer surgery: A systematic review and meta-analysis. Int Wound J 2024; 21:e14603. [PMID: 38155392 PMCID: PMC10961893 DOI: 10.1111/iwj.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/09/2023] [Accepted: 12/10/2023] [Indexed: 12/30/2023] Open
Abstract
Surgical site infections (SSIs) pose significant risks to patients undergoing colorectal cancer (CRC) surgery. With increasing evidence on the benefits of oral probiotics in various clinical contexts, there is a need to assess their efficacy and safety in reducing SSIs following CRC surgery. A systematic review and meta-analysis were conducted in line with PRISMA guidelines using the PICO framework. On 19 September 2023, four major databases (PubMed, Embase, Web of Science and Cochrane Library) were searched without any temporal or language restrictions. Rigorous inclusion and exclusion criteria were employed. Data extraction was independently undertaken by two assessors, and any discrepancies were discussed. The Cochrane Collaboration's risk of bias instrument was utilized to assess study quality. The meta-analysis incorporated a fixed-effects model or random-effects model based on the I2 statistic to assess heterogeneity. The initial search yielded 1282 articles, of which 10 met the inclusion criteria and were analysed. Probiotic administration not only significantly reduced the incidence of SSIs but also curtailed the duration of hospital stays. Moreover, the subgroup analysis indicated that interventions employing multiple strains of probiotics were more effective in reducing postoperative infections than those utilizing a single strain. Probiotics effectively prevent postoperative infections and shorten hospital stays. Multi-strain probiotics outperform single strain in efficacy. Future studies should focus on their safety and optimal clinical use.
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Affiliation(s)
- Jiahong Chen
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
- Department of Venereal Diseases and Integrated Chinese and Western Medicine and Bone ParalysisThe Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District)FoshanChina
| | - Jie Zhao
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
- Personnel SectionHuadu Clinical Medical College of Guangdong Medical University (Maternal and Child Health Hospital)GuangzhouChina
| | - Hongfu Wu
- Dongguan Key Laboratory of Stem Cell and Regenerative Tissue Engineering, The First Dongguan Affiliated HospitalGuangdong Medical UniversityDongguanChina
| | - Tao Wang
- Department of Venereal Diseases and Integrated Chinese and Western Medicine and Bone ParalysisThe Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District)FoshanChina
| | - Cifeng Gao
- Personnel SectionHuadu Clinical Medical College of Guangdong Medical University (Maternal and Child Health Hospital)GuangzhouChina
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Hounchonou HF, Bajgora G, Esmaeilzadeh M, Hartmann C, Krauss JK. Surgical site infections after glioblastoma surgery: boon or bane? J Cancer Res Clin Oncol 2024; 150:36. [PMID: 38279060 PMCID: PMC10817840 DOI: 10.1007/s00432-023-05528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/13/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Surgical site infections (SSIs) are among the most common postoperative complications. Glioblastoma multiforme is the most frequent malignant brain tumor with a dismal prognosis despite combined treatment. The effect of SSIs on the course of glioblastoma patients has not been fully clarified since available data are limited and partially contradictory. The aim of this study is to investigate the impact of SSIs on the course of patients with glioblastoma. METHODS The medical records of all patients undergoing surgery for glioblastoma between 2010 and 2020 in our institution were scanned and those with surgical site infections after glioblastoma resection were identified and compared to an age-matched control group. Overall survival and progression-free survival were the primary endpoints followed by the number of hospitalizations and the length of stay in hospital. RESULTS Out of 305 patients undergoing surgery for glioblastoma, 38 patients with postoperative surgical site infection after resection were identified and 15 (5 men and 10 women aged between 9 and 72) were included in this study. 23 patients were excluded. The control group consisted of 30 age-matched patients without SSI (18 men and 12 women). There were no significant differences in median overall survival. Progression-free survival was higher in the SSI group. The number of hospitalizations and the length of stay were significantly higher in the SSI group. CONCLUSION Our data suggest that SSIs might reduce early recurrences without affecting overall survival. Furthermore, they might decrease health-related quality of life by doubling the total length of hospital stay.
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Affiliation(s)
- Harold F Hounchonou
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Genis Bajgora
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Majid Esmaeilzadeh
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Chen Y, Guo H, Gao T, Yu J, Wang Y, Yu H. A meta-analysis of the risk factors for surgical site infection in patients with colorectal cancer. Int Wound J 2023; 21:e14459. [PMID: 37904719 PMCID: PMC10828529 DOI: 10.1111/iwj.14459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/01/2023] Open
Abstract
The purpose of the meta-analysis was to evaluate and compare the surgical site infection (SSI) risk factors in patients with colorectal cancer (CC). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random or fixed-effect models. For the current meta-analysis, 23 examinations spanning from 2001 to 2023 were included, encompassing 89 859 cases of CC. Clean-contaminated surgical site wounds had significantly lower infections (OR, 0.36; 95% CI, 0.20-0.64, p < 0.001) compared to contaminated surgical site wounds in patients with CCs. Males had significantly higher SSIs (OR, 1.18; 95% CI, 1.12-1.24, p < 0.001) compared to females in patients with CC. American Society of Anesthesiology score ≥3 h had a significantly higher SSI (OR, 1.42; 95% CI, 1.18-1.71, p < 0.001) compared to <3 score in patients with CCs. Body mass index ≥25 had significantly higher SSIs (OR, 1.54; 95% CI, 1.11-2.14, p = 0.01) compared to <25 in patients with CCs. The presence of stoma creation had a significantly higher SSI rate (OR, 2.28; 95% CI, 1.37-3.79, p = 0.001) compared to its absence in patients with CC. Laparoscopic surgery had significantly lower SSIs (OR, 0.68; 95% CI, 0.59-0.78, p < 0.001) compared to open surgery in patients with CC. The presence of diabetes mellitus had a significantly higher SSI rate (OR, 1.24; 95% CI, 1.15-1.33, p < 0.001) compared to its absence in patients with CCs. No significant difference was found in SSI rate in patients with CCs between <3 and ≥3 h of operative time (OR, 1.07; 95% CI, 0.75-1.51, p = 0.72), between the presence and absence of blood transfusion (OR, 1.60; 95% CI, 0.69-3.66, p = 0.27) and between the presence and absence of previous laparotomies (OR, 1.47; 95% CI, 0.93-2.32, p = 0.10). The examined data revealed that contaminated wounds, male sex, an American Society of Anesthesiology score ≥3 h, a body mass index ≥25, stoma creation, open surgery and diabetes mellitus are all risk factors for SSIs in patients with CC. However, operative time, blood transfusion and previous laparotomies were not found to be risk factors for SSIs in patients with CC. However, given that several comparisons had a small number of chosen research, consideration should be given to their values.
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Affiliation(s)
- Yani Chen
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
| | - Hua Guo
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
| | - Tian Gao
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
| | - Jiale Yu
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
| | - Yujia Wang
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
| | - Haiquan Yu
- The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, College of Life ScienceInner Mongolia UniversityHohhotInner MongoliaChina
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Li D, Ding S, Li J, Liao X, Ru K, Liu L, Shang W. Diagnostic value of inflammatory indicators for surgical site infection in patients with breast cancer. Front Cell Infect Microbiol 2023; 13:1286313. [PMID: 37953798 PMCID: PMC10634473 DOI: 10.3389/fcimb.2023.1286313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/05/2023] [Indexed: 11/14/2023] Open
Abstract
Background Breast cancer is the most commonly diagnostic cancer in women worldwide. The main treatment for these patients is surgery. However, there is a high incidence of surgical site infection (SSI) in breast cancer patients. The aim of this study was to identify effective infection-related diagnostic markers for timely diagnosis and treatment of SSI. Methods This retrospective study included 263 breast cancer patients who were treated between July 2018 and March 2023 at the Shandong Cancer Hospital and Institute. We analyzed differences between the SSI group and control group and differences before and during infection in the SSI group. Finally, we tested the distribution of pathogenic microorganisms and their susceptibility to antibiotics. Results Compared with preoperative inflammatory indicators, white blood cells (WBC), neutrophils (NEU), absolute neutrophil count to the absolute lymphocyte count (NLR), D2 polymers (D-Dimer) and fibrinogen (FIB) were significantly increased, while lymphocytes (LYM), albumin (ALB) and prealbumin (PA) were significantly decreased in the SSI group. Compared with uninfected patients, WBC, NEU, NLR and FIB were significantly increased, ALB and PA were significantly decreased in SSI patients, while LYM and D-Dimer did not differ significantly. The distribution of infection bacteria in SSI patients showed that the proportion of patients with Staphylococcus aureus infection was as high as 70.41%; of those patients, 19.33% had methicillin-resistant Staphylococcus aureus (MRSA) infection. The area under the curves (AUCs) of the receiver operating curves (ROCs) for WBC, NEU, NLR, FIB, ALB and PA were 0.807, 0.811, 0.730, 0.705, 0.663 and 0.796, respectively. The AUCs for other inflammatory indicators were not statistically significant. There was no significant difference in antibiotic resistance for Staphylococcus aureus when compared to that of gram-positive bacteria. The resistance of gram-positive bacteria to ceftriaxone (CRO), cefoxitin (FOX), chloramphenicol (CHL), minocycline (MNO) and tetracycline (TCY) was lower than that of gram-negative bacteria, while the resistance to gentamicin (GEN) was higher. Conclusion This study demonstrated that WBC, NEU, NLR, FIB and PA have good predictive value for identifying patients at risk of SSI. The cut-off values of inflammatory indicators can be helpful in the prevention and diagnosis of SSI.
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Affiliation(s)
| | | | | | | | | | | | - Wenjing Shang
- Department of Clinical Laboratory, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
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Shimane T, Koike K, Fujita S, Kurita H, Isomura ET, Chikazu D, Kanno N, Sasaki K, Hino S, Hibi H, Koyama T, Nakamura S, Nomura T, Mori Y, Tojyo I, Yamamoto T, Yamamori I, Aota K, Tanzawa H. Positive impact of perioperative oral management on the risk of surgical site infections after abdominal surgery: Sixteen universities in Japan. Medicine (Baltimore) 2023; 102:e35066. [PMID: 37713859 PMCID: PMC10508462 DOI: 10.1097/md.0000000000035066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/14/2023] [Indexed: 09/17/2023] Open
Abstract
Surgical site infections (SSI) are associated with increased morbidity and mortality rates. This study aimed to investigate the ability of perioperative oral management (POM) to reduce the risk of SSI in abdominal surgery Real-world data collected from 16 university hospitals in Japan were reviewed. The medical records of consecutive 2782 patients (1750 men and 1032 women) who underwent abdominal surgery under general anesthesia at 16 university hospitals were retrospectively reviewed. Detailed information about SSI was assessed and compared between patients with and without POM in univariate and multivariate analyses. SSI were observed in 275 patients (incidence rate:9.9%), and POM was administered to 778 patients (28.0%). Univariate analyses revealed that diabetes mellitus, Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists classification, surgical site, preoperative Prognostic Nutritional Index score, POM, extent of surgery, operation time, and intraoperative blood loss were significantly associated with postoperative SSI (Chi-square or Mann-Whitney U test, P < .01). Multivariate analysis revealed that POM had significant preventive effects against postoperative SSI (estimate: -0.245, standard error: 0.080, P < .01). Surgical site, American Society of Anesthesiologists classification, and operation time were also significant and independent clinical predictors of SSI. The analysis of real-world data from 16 university hospitals revealed that, regardless of the content and degree of the problem, the addition of POM has significant beneficial effects in reducing the risk of SSI in patients who undergo abdominal surgery. Medical records from each hospital and data from the Health Care Payment Fund were collected and analyzed retrospectively.
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Affiliation(s)
- Tetsu Shimane
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuyuki Koike
- Department of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, Japan
| | - Shigeyuki Fujita
- Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Kurita
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Emiko Tanaka Isomura
- First Department of Oral and Maxillofacial Surgery, Osaka University, Graduate School of Dentistry: Unit of Dentistry, Osaka University Hospital, Suita, Japan
| | - Daichi Chikazu
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Naomi Kanno
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Satoshi Hino
- Department of Oral and Maxillofacial Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hideharu Hibi
- Department of Oral and Maxillofacial Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Koyama
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Seiji Nakamura
- Section of Maxillofacial Oncology, Division of Maxillofacial Diagnostic and Surgical Sciences, Faculty of Dental Science, Kyushu University, Fukuoka, Japan
| | - Takeshi Nomura
- Department of Oral Medicine, Oral and maxillofacial Surgery, Tokyo Dental College, Chiba, Japan
| | - Yoshiyuki Mori
- Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University, Tochigi, Japan
| | - Itaru Tojyo
- Oral and Maxillofacial Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toshiro Yamamoto
- Department of Dental Medicine, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Iku Yamamori
- Department of Dentistry and Oral Surgery, Yamagata University Hospital, Yamagata, Japan
| | - Keiko Aota
- Department of Oral Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hideki Tanzawa
- Department of Dentistry and Oral-Maxillofacial Surgery, Chiba University Hospital, Chiba, Japan
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Huang W, Wei ZQ, Qiu YH, Tang G, Sun H. Effects of wound infection on prognosis after laparoscopic abdominoperineal resection of rectal cancer. Front Oncol 2023; 12:1036241. [PMID: 36686786 PMCID: PMC9846744 DOI: 10.3389/fonc.2022.1036241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background In two facilities in Chongqing, this research sought to retrospectively evaluate the effects of perineal wound infection on survival after laparoscopic abdominoperineal resection (LAPR) of rectal cancer. Methods To obtain clinical information on patients who underwent LAPR between January 2013 and December 2021, we performed a multicenter cohort study. A total of 473 patients were enrolled: 314 in the non-infection group and 159 in the group with perineal infection. The general data, perioperative conditions, and tumor outcomes between groups were analyzed. The infection rates, recurrence rates, and survival rates of the two centers were compared. Results The age, height, weight, body mass index (BMI), preoperative complications, preoperative treatment, and intraoperative conditions of patients in the LAPR infection group were not statistically different from those in the non-infection group. The percentage of men, typical postoperative hospital stay, length of initial postoperative therapy, and recurrence and metastasis rates were all considerably higher in the infection group than those in the non-infection group. Wound infection was an independent factor affecting tumor recurrence and metastasis after LAPR as well as an independent factor shortening patient survival time according to multivariate analysis. The incidence of wound infection, the rate of recurrence, and the rate of mortality did not vary significantly across sites. Conclusion Wound infection after LAPR increases the mean postoperative hospital stay, prolongs the time to first postoperative treatment, and decreases the disease-free survival (DFS) and overall survival (OS). Therefore, decreasing the rate of LAPR wound infection is expected to shorten the postoperative hospital stay and prolong the patient DFS and OS. Patients with postoperative infection may require intensive adjuvant therapy.
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Affiliation(s)
- Wang Huang
- Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Zheng-qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-hao Qiu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Sun
- Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, China,*Correspondence: Hao Sun,
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Triclosan-coated barbed sutures in elective laparoscopic colorectal cancer surgery: a propensity score matched cohort study. Surg Endosc 2023; 37:209-218. [PMID: 35918550 PMCID: PMC9839817 DOI: 10.1007/s00464-022-09418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/24/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Most of the studies published to date which assess the role of antibacterial sutures in surgical site infection (SSI) prevention include heterogeneous groups of patients, and it is therefore difficult to draw conclusions. The objective of the present study was to investigate whether the use of Triclosan-coated barbed sutures (TCBS) was associated with a lower incidence of incisional SSI and lower duration of hospital stay compared to standard sutures, in elective laparoscopic colorectal cancer surgery. METHOD Observational including patients who underwent elective colorectal cancer laparoscopic surgery between January 2015 and December 2020. The patients were divided into two groups according to the suture used for fascial closure of the extraction incision, TCBS vs conventional non-coated sutures (CNCS), and the rate of SSI was analysed. The TCBS cases were matched to CNCS cases by propensity score matching to obtain comparable groups of patients. RESULTS 488 patients met the inclusion criteria. After adjusting the patients with the propensity score, two new groups of patients were generated: 143 TCBS cases versus 143 CNCS cases. Overall incisional SSI appeared in 16 (5.6%) of the patients with a significant difference between groups depending on the type of suture used, 9.8% in the group of CNCS and 1.4% in the group of TCBS (OR 0.239 (CI 95%: 0.065-0.880)). Hospital stay was significantly shorter in TCBS group than in CNCS, 5 vs 6 days (p < 0.001). CONCLUSION TCBS was associated with a lower incidence of incisional SSI compared to standard sutures in a cohort of patients undergoing elective laparoscopic colorectal cancer surgery.
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Utsumi M, Yamada T, Yamabe K, Katsura Y, Fukuchi N, Fukunaga H, Tanemura M, Shimizu J, Kagawa Y, Kobayashi S, Takahashi H, Tanaka K, Mizushima T, Eguchi H, Nakayama N, Makimoto K, Doki Y. Differences in risk factors for surgical site infection between laparotomy and laparoscopy in gastrointestinal surgery. PLoS One 2022; 17:e0274887. [PMID: 36121818 PMCID: PMC9484690 DOI: 10.1371/journal.pone.0274887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Extensive gastrointestinal surgery surveillance data in Japan were analyzed to examine the differences in the risk factors for surgical site infection (SSI) between laparotomy and laparoscopic abdominal procedures. Surgical procedures investigated in the study were gastrectomy, cholecystectomy, colectomy, rectal resection, and appendectomy. A total of 32,629 patients were included in the study. The study participants were divided into two groups according to the year of surgery, 2003–2009 (first study period) and 2010–2015 (second study period), due to the increase in the number of laparoscopic surgeries in the second study period. The incidence of SSI was stratified by three SSI classifications (superficial incisional, deep incisional, and organ/space SSI). Multiple logistic regression analysis was performed to predict the risk factors for SSI. The percentage of laparoscopic surgeries performed has increased linearly since 2010. Patients in the second study period were significantly older and had a higher prevalence of SSI risk factors compared with those in the first study period. In addition, the predictive factors changed substantially in most surgical procedures between the two study periods. Wound class ≥ 3 was a ubiquitous risk factor for superficial incisional SSI (SI-SSI) and organ/space SSI (OS-SSI) in both open (laparotomy) and laparoscopic procedures in the first study period. Meanwhile, in the second study period, operative duration was a ubiquitous risk factor in both procedures. The risk factors for SI-SSI differed from those for OS-SSI in the five abdominal surgeries investigated in the study. Periodic examination of risk factors for SSI is recommended in an aging society.
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Affiliation(s)
- Momoe Utsumi
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
- * E-mail:
| | - Terumasa Yamada
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka City, Osaka, Japan
| | - Kazuo Yamabe
- Department of Surgery, Kinan Hospital, Tnabe City, Osaka, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki City, Hyogo, Japan
| | - Nariaki Fukuchi
- Department of Surgery, Suita Municipal Hospital, Suita City, Osaka, Japan
| | - Hiroki Fukunaga
- Department of Surgery, Itami City Hospital, Itami City, Hyogo, Japan
| | - Masahiro Tanemura
- Department of Surgery, Rinku General Medical Center, Izumisano City, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka City, Osaka, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka City, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | | | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
| | - Nana Nakayama
- Department of Nursing, Kyoto University Hospital, Kyoto City, Kyoto, Japan
| | - Kiyoko Makimoto
- Emeritus Professor, Osaka University, Suita City, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita City, Osaka, Japan
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11
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The Microbiota and the Relationship with Colorectal Cancer: Surgical Complications—A Review. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4020008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common cancers and represents a major global health burden. While genetics are implicated in a portion of CRC patients, most cases are sporadic. A new possibility of tumor initiation and promotion might be microbiome composition. It was recently shown that bacteria from the gut microbiome might be used as biomarkers for CRC detection, especially Fusobacterium nucleatum, Peptostreoptococcus stomatis, Parvimonas mica, Solobacterium moorei, and Peptostreptococcus anaerobius. Conversely, the healthy gut microbiome is mostly colonized by Bacterioides (Bacterioides fragilis, vulgatus, uniformis), Firmicutes (Clostridium spp., Ruminococcus faecis, Enterococcus faecium), and Actinobacteria (Bifidobacterium bifidum). Some strains of gut bacteria favor tumor promotion through DNA and RNA damage (directly or through interaction with other known food carcinogens) and through local immune inhibition. It is possible that bacteria (e.g., Bacillus polyfermenticus, Alistipes shahii, Lactobacillus casei) exist with protective functions against tumor promotion. Despite current advances in colorectal cancer treatment, especially in the medical oncology and radiotherapy domains, surgery remains the mainstay of curative treatment for colorectal cancer patients, even in the oligometastatic setting. Surgical complications like anastomotic leakage, excessive blood loss, abscess, and abdominal sepsis can reduce 1-year and 5-year overall survival and increase the recurrence rates for these patients; therefore, we reviewed currently published data focusing on the relationship between gut microbiota and postoperative complications for colorectal cancer patients.
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12
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Sugamata N, Okuyama T, Takeshita E, Oi H, Hakozaki Y, Miyazaki S, Takada M, Mitsui T, Noro T, Yoshitomi H, Oya M. Surgical site infection after laparoscopic resection of colorectal cancer is associated with compromised long-term oncological outcome. World J Surg Oncol 2022; 20:111. [PMID: 35387666 PMCID: PMC8988355 DOI: 10.1186/s12957-022-02578-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Nana Sugamata
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Okuyama
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Emiko Takeshita
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Haruka Oi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Yuhei Hakozaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Shunya Miyazaki
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Musashi Takada
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Mitsui
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takuji Noro
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Hideyuki Yoshitomi
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Masatoshi Oya
- Department of Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan
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13
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Lee KY, Lee J, Park YY, Oh ST. Use of gentamicin-collagen sponge (Collatamp® G) in minimally invasive colorectal cancer surgery: A propensity score-matched study. PLoS One 2022; 17:e0264513. [PMID: 35344540 PMCID: PMC8959166 DOI: 10.1371/journal.pone.0264513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Minimally invasive surgery is commonly used to treat patients with colorectal cancer, although it can cause surgical site infections (SSIs) that can affect the oncologic outcome. Use of a gentamicin-collagen sponge may help reduce the occurrence of SSIs. We aimed to determine the effectiveness of a gentamicin-collagen sponge in reducing SSIs in minimally invasive surgery for colorectal cancer. Methods We retrospectively reviewed the records of 310 patients who were diagnosed with colorectal cancer at our hospital and underwent minimally invasive surgery between December 1, 2018, and February 28, 2021. Propensity score matching was conducted with a 1:1 ratio using logistic regression. The primary outcome was the incidence of SSIs in the mini-laparotomy wound. The secondary endpoints were factors affecting the incidence of SSIs. Results After propensity score matching, 130 patients were assigned to each group. There were no differences in clinical characteristics between the two groups. SSIs occurred in 2 (1.5%) and 3 (2.3%) patients in the gentamicin-collagen sponge and control groups, respectively (p<0.999). The following factors showed a statistically significant association with SSIs: body mass index >25 kg/m2 (odds ratio, 39.0; 95% confidence interval, 1.90–802.21; p = 0.018), liver disease (odds ratio, 254.8; 95% confidence interval, 10.43–6222.61; p = 0.001), and right hemicolectomy (odds ratio, 36.22; 95% confidence interval, 2.37–554.63; p = 0.010). Conclusion Applying a gentamicin-collagen sponge to the mini-laparotomy wound did not reduce the frequency of SSIs. Further studies should be conducted on whether the selective use of gentamicin-collagen sponges may help reduce SSIs in high-risk patients.
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Affiliation(s)
- Kil-yong Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
| | - Jaeim Lee
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
- * E-mail:
| | - Youn Young Park
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
| | - Seong Taek Oh
- Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea
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14
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Raftery NB, Murphy CF, Donlon NE, Heneghan H, Donohoe CL, King S, O'Connell B, Ravi N, Reynolds JV. Prospective study of surgical site infections post-open esophageal cancer surgery, and the impact of care bundles. Dis Esophagus 2021; 34:6137282. [PMID: 33590037 DOI: 10.1093/dote/doaa136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/18/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022]
Abstract
SSIs represent common infection-related morbidity following major surgery. Modern care bundles have been established as prophylactic measures aimed at preventing SSI occurring postoperatively. SSI incidence and data on common culprit pathogens post-esophagectomy for cancer have not been previously reported. Patients (2013-2018) treated with curative intent were studied. SSI was defined as per the Center for Disease Control (CDC) definition. A care bundle pathway following the National Institute for Clinical Excellence (NICE) guidelines for prevention of SSIs was introduced in 2013 and was audited quarterly. Risk factors and associations of SSIs were analyzed, as was the prevalence of isolated pathogens. Multivariable logistic regression examined independently predictive factors of SSIs and oncologic outcomes. Of 343 patients, 34 (9.9%) developed a postoperative SSI, with a median (range) of 8 (6-17). Quarterly audit carried out over 6 years showed no significant annual variance or trend. The most prevalent pathogen cultured was Methicillin-sensitive Staphylococcus aureus (MSSA) in nine patients (32%) followed by Candida albicans (29%), Escherichia coli (14%), and Enterococcus faecium (11%). SSI was significantly associated with pneumonia (P = 0.001), respiratory failure (P = 0.014), atrial fibrillation (P = 0.004), anastomotic leak (P < 0.001), and in-hospital blood transfusions (P = 0.031). SSI did not impact the overall survival (P = 0.951). SSI rates can be maintained at less than 10% using strict care bundles and regular audit. The most common culprit pathogen is gram-positive MSSA representing 32% of cases. These data are novel and may represent a modern benchmark for SSI post-open esophagectomy for cancer. This study highlights the incidence and associations of SSI post-esophageal cancer surgery.
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Affiliation(s)
- Nicola B Raftery
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Conor F Murphy
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Noel E Donlon
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Helen Heneghan
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Claire L Donohoe
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Sinead King
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Brian O'Connell
- Department of Microbiology, St James's Hospital, Dublin, Ireland
| | - Narayanasamy Ravi
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - John V Reynolds
- National Esophageal and Gastric Center, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
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15
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Warps AK, Tollenaar RAEM, Tanis PJ, Dekker JWT. Postoperative complications after colorectal cancer surgery and the association with long-term survival. Eur J Surg Oncol 2021; 48:873-882. [PMID: 34801319 DOI: 10.1016/j.ejso.2021.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/22/2021] [Accepted: 10/30/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Complications after colorectal cancer surgery can worsen long-term survival. The aim of this nationwide study was to determine the impact of different types of complications on overall survival (OS) and conditional survival if still alive one year postoperatively (CS-1) after colorectal cancer surgery. MATERIALS AND METHODS All patients registered in the Dutch ColoRectal Audit after resection of primary colorectal cancer between 2011 and 2017 and with known survival status were included. Multivariable Cox regression models were used to assess the association of complications with OS and CS-1, thereby calculating the Hazard Ratio (HR) with 95% Confidence Interval. RESULTS 43,908 colon and 16,955 rectal cancer patients were included. Median follow-up time was 66.1 and 66.5 months, respectively. Five-year OS after colon cancer resection was 73.2% without complications, and 65.4% with surgical, 52.9% with non-surgical and 51.8% with combined type of complications (p < 0.001). Corresponding 5-year OS for rectal cancer patients was 76.9%, 72.7%, 64.9%, and 63.2% (p < 0.001). In colon cancer, multivariable analyses revealed HR 1.198 (1.136-1.264) for surgical, HR 1.489 (1.423-1.558) for non-surgical and HR 1.590 (1.505-1.681) for combined type of complications. For rectal cancer, these HRs were 1.193 (1.097-1.2297), 1.456 (1.346-1.329), and 1.489 (1.357-1.633). Surgical complications were associated with worse CS-1 in rectal cancer (HR 1.140 (1.050-1.260), but not in colon cancer (HR 1.007 (0.943-1.075)). CONCLUSION Non-surgical complications have higher impact on survival than surgical complications. The impact of surgical complications on survival was still measurable after surviving the first year in rectal cancer but not in colon cancer patients.
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Affiliation(s)
- A K Warps
- Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA, Leiden, the Netherlands
| | - R A E M Tollenaar
- Leiden University Medical Centre, Department of Surgery, Albinusdreef 2, 2333, ZA, Leiden, the Netherlands; Dutch Institute for Clinical Auditing, Rijnsburgerweg 10, 2333, AA, Leiden, the Netherlands
| | - P J Tanis
- Amsterdam University Medical Centres, Department of Surgery, University of Amsterdam, Cancer Centre Amsterdam, 1117 Boelelaan, 1081, HV, Amsterdam, the Netherlands
| | - J W T Dekker
- Reinier de Graaf Groep, Department of Surgery, Reinier de Graafweg 5, 2625, AD, Delft, the Netherlands.
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16
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Chiappini A, Santos AN, DE Trizio I, Croci D, Valci L, Reinert M, Marchi F. Longer survival of glioblastoma complicated by bacterial infections after surgery: what is known today. J Neurosurg Sci 2021; 65:524-531. [PMID: 33940776 DOI: 10.23736/s0390-5616.21.05277-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glioblastoma is the most common primary brain tumor in adults with the worst overall survival. Post-craniotomy intracranial infections are not infrequent after surgery, however their impact on overall survival of glioblastoma patients remains unclear. Here we report the case of an unusual longer survival of a glioblastoma patient affected by multiple infections and review the literature on this topic. METHODS PubMed, Embase and Cochrane search engines were reviewed for papers describing outcome of patients suffering from glioblastoma and associated cerebral infections. RESULTS Four papers accounting a total of 29 patients met the eligibility criteria. Staphylococcus aureus and Staphylococcus epidermidis resulted the most common bacteria causing post-craniotomy intracranial infections in brain tumor patients. The overall median survival rate was 18 months ± 18.12 when adding all 29 patients. Only one study described a significant higher survival rate for the infected group. CONCLUSIONS Glioblastoma is the most frequent malignant brain tumor with a very poor outcome/survival. In the literature few cases described an exceptional longer survival often associated with a postoperative infection. To date, the pathophysiology behind this longer survival remains unclear, but it seems that Staphylococcus species could have an influence on the progression of this aggressive brain tumor.
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Affiliation(s)
- Alessio Chiappini
- Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland - .,Faculty of Medicine, University of Basel, Basel, Switzerland -
| | - Alejandro N Santos
- Department of Neurosurgery, University Hospital of Essen, Essen, Germany
| | - Ignazio DE Trizio
- Department of Intensive Care Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | - Davide Croci
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Luca Valci
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
| | - Michael Reinert
- Department of Neurosurgery, Hirslanden Neurological and Spinal Surgery Center, Klinik St. Anna, Lucerne, Switzerland
| | - Francesco Marchi
- Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland
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17
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Johnson BH, Rai P, Jang SR, Johnston SS, Chen BPH. Real-World Outcomes of Patients Undergoing Open Colorectal Surgery with Wound Closure Incorporating Triclosan-Coated Barbed Sutures: A Multi-Institution, Retrospective Database Study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2021; 14:65-75. [PMID: 33658869 PMCID: PMC7917355 DOI: 10.2147/mder.s297671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Open colorectal surgery is associated with a high rate of postoperative wound complications. This is a single-arm study of real-world outcomes of triclosan-coated barbed suture (Ethicon's STRATAFIXTM Symmetric PDSTM Plus Knotless Tissue Control Device [SSPP]) used in open colorectal surgery. Methods Retrospective cohort study using the Premier Healthcare Database. The study included patients who underwent an inpatient open colorectal surgery with wound closure using SSPP (size 0 or 1 to increase the likelihood the suture was used in fascia) between October 2015-September 2019 (N=593). Wound complications, hospital length of stay, total hospital costs (2019 US$), and all-cause readmissions post-discharge were measured. Post-hoc multivariable analyses compared wound complications between non-elective admissions and elective. Results The overall incidence of wound complications within 30-days post-procedure was 7.1%, with the majority of those being surgical site infections (SSI) (6.0%). Mean operation time was 190 (standard deviation [SD]=64.4) mins, postoperative length of stay was 8.1 (SD=11.9) days, 30-day readmission rate was 11.8%, and total hospital costs were $31,693 (SD=$40,076). As compared with published literature on the rate of SSI in colorectal surgery, the 30-day rate of SSI in the present study (6.0%) fell within the range of 5.4% to 18.2% for open colorectal surgery and from 4.3% to 21.5% for combined open and minimally invasive procedures. Multivariable-adjusted incidence proportions of wound complications were slightly lower for non-elective admissions and did not differ significantly from those of elective admissions. Conclusion The rate of wound complications observed in the present study falls within the range of rates previously reported in the literature, suggesting a safe and effective role for SSPP in open colorectal surgery. In post hoc analyses, the adjusted rate of wound complications was similar between non-elective and elective admissions. Head-to-head studies are required to determine comparative advantages or disadvantages for SSPP versus other sutures.
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Affiliation(s)
- Barbara H Johnson
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Pragya Rai
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Se Ryeong Jang
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen S Johnston
- Real World Data Analytics and Research, Epidemiology, Medical Devices, Johnson & Johnson, New Brunswick, NJ, USA
| | - Brian Po-Han Chen
- Health Economics and Market Access, Ethicon Inc., Somerville, NJ, USA
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18
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Mc Geehan G, Edelduok IM, Bucholc M, Watson A, Bodnar Z, Johnston A, Sugrue M. Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement. Life (Basel) 2021; 11:life11020138. [PMID: 33670186 PMCID: PMC7916918 DOI: 10.3390/life11020138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022] Open
Abstract
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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Affiliation(s)
- Gearóid Mc Geehan
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- School of Medicine, University of Limerick, V94T9PX Limerick, Ireland
| | - Itoro M Edelduok
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University (Magee Campus), Northern Ireland BT48 7JL, UK
| | - Angus Watson
- Raigmore Hospital, NHS-Highland, Inverness IV2 3DZ, UK
| | - Zsolt Bodnar
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Alison Johnston
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
| | - Michael Sugrue
- Donegal Clinical Research Academy, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Department of Surgery, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
- Emergency Surgery Outcome Advancement Project, Letterkenny University Hospital, F92AE81 County Donegal, Ireland
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19
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Xu Z, Qu H, Kanani G, Guo Z, Ren Y, Chen X. Update on risk factors of surgical site infection in colorectal cancer: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35:2147-2156. [PMID: 32748113 DOI: 10.1007/s00384-020-03706-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Surgical site infection (SSI) in colorectal cancer (CRC) has been a serious health care problem due to the delay of postoperative recovery. Our present study aimed to explore the risk factors for SSI in CRC patients. METHODOLOGY We have systematically searched these databases: PubMed, Cochrane Library, and EMBASE as of March 2020 for studies on risk factors associated with SSI. Two investigators independently conducted the quality assessment and data extraction. Related risk factors in the studies were recorded, and a meta-analysis was performed. RESULTS The search initially provided 2262 hits, 1913 studies were screened by two independent investigators. Finally, 15 studies were identified to be relevant for this meta-analysis. In total, 25 risk factors were eligible. Our meta-analysis indicated that eight factors (obesity, male sex, diabetes mellitus, ASA score ≥ 3, stoma creation, intraoperative complications, perioperative blood transfusion, and operation time ≥ 180 min) were significant risk factors for SSI, and one factor (laparoscopic procedure) was protective for SSI. CONCLUSIONS Effective interventions targeting the above factors may reduce the risk of developing postoperative SSI in CRC patients and improve the clinical outcome of patients. Further prospective studies are needed to confirm these findings.
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Affiliation(s)
- Zhaohui Xu
- Dalian Medical University, Dalian, China
| | - Hui Qu
- Dalian Medical University, Dalian, China
| | | | - Zhong Guo
- Dalian Medical University, Dalian, China
| | - Yanying Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, 467 Zhong Shan Road, Dalian, 116023, People's Republic of China.
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20
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Koliarakis I, Athanasakis E, Sgantzos M, Mariolis-Sapsakos T, Xynos E, Chrysos E, Souglakos J, Tsiaoussis J. Intestinal Microbiota in Colorectal Cancer Surgery. Cancers (Basel) 2020; 12:cancers12103011. [PMID: 33081401 PMCID: PMC7602998 DOI: 10.3390/cancers12103011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/04/2020] [Accepted: 10/13/2020] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The microbial communities of the intestine exist in a delicate balance with the human. Colorectal cancer is one of the most common gastrointestinal malignancies, and the microbiota seems to be related to it. The intestinal microbiota of patients after colorectal surgery is changed due to surgical stress and other perioperative factors. The occurrence of complications after colorectal cancer (CRC) surgery may depend on these bacterial shifts, which could also be associated with prognosis and survival in postoperative CRC patients. Abstract The intestinal microbiota consists of numerous microbial species that collectively interact with the host, playing a crucial role in health and disease. Colorectal cancer is well-known to be related to dysbiotic alterations in intestinal microbiota. It is evident that the microbiota is significantly affected by colorectal surgery in combination with the various perioperative interventions, mainly mechanical bowel preparation and antibiotic prophylaxis. The altered postoperative composition of intestinal microbiota could lead to an enhanced virulence, proliferation of pathogens, and diminishment of beneficial microorganisms resulting in severe complications including anastomotic leakage and surgical site infections. Moreover, the intestinal microbiota could be utilized as a possible biomarker in predicting long-term outcomes after surgical CRC treatment. Understanding the underlying mechanisms of these interactions will further support the establishment of genomic mapping of intestinal microbiota in the management of patients undergoing CRC surgery.
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Affiliation(s)
- Ioannis Koliarakis
- Laboratory of Anatomy, School of Medicine, University of Crete, 70013 Heraklion, Greece;
| | - Elias Athanasakis
- Department of General Surgery, University Hospital of Heraklion, 71110 Heraklion, Greece; (E.A.); (E.C.)
| | - Markos Sgantzos
- Laboratory of Anatomy, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41334 Larissa, Greece;
| | - Theodoros Mariolis-Sapsakos
- Surgical Department, National and Kapodistrian University of Athens, Agioi Anargyroi General and Oncologic Hospital of Kifisia, 14564 Athens, Greece;
| | - Evangelos Xynos
- Department of Surgery, Creta Interclinic Hospital of Heraklion, 71305 Heraklion, Greece;
| | - Emmanuel Chrysos
- Department of General Surgery, University Hospital of Heraklion, 71110 Heraklion, Greece; (E.A.); (E.C.)
| | - John Souglakos
- Laboratory of Translational Oncology, School of Medicine, University of Crete, 71003 Heraklion, Greece;
| | - John Tsiaoussis
- Laboratory of Anatomy, School of Medicine, University of Crete, 70013 Heraklion, Greece;
- Correspondence: ; Tel.: +30-2810-394716
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21
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Abstract
PURPOSE To date, there have been many studies on postoperative complications and oncologic outcomes, but the findings remain controversial. The purpose of the study was to determine the prognostic value of serum inflammatory markers as pretreatment in curatively resected colorectal cancer. The effects of serum inflammatory marker levels on postoperative morbidity were also examined. METHODS Prospectively collected data from 1590 patients with primary sporadic colorectal adenocarcinoma who underwent curative resection between September 2012 and December 2013 at our institution were retrospectively analyzed. White blood cell count (× 103/mcl), neutrophil/lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate (ESR), and Glasgow prognostic score (GPS) were evaluated. GPS was determined as follows: GPS of 2, elevated CRP level (> 1.0 mg/dl) and hypoalbuminemia (< 3.5 g/dl); GPS of 1, elevated CRP or hypoalbuminemia; and GPS of 0, neither elevated CRP nor hypoalbuminemia. RESULTS The median follow-up period for the 1590 patients was 59 months. The overall postoperative morbidity rate was 24.8%. In multivariate analysis, female sex (P = 0.006), rectal cancer other than colon cancer (P < 0.001), CEA level > 5 ng/ml (P < 0.001), ESR > 27 mm/h (P = 0.014), and a GPS of 1 or 2 (P < 0.001) were independent risk predictors for morbidity. A GPS of 1 or 2 (P < 0.001) and postoperative morbidity (P < 0.001) significantly affected both overall survival and disease-free survival in multivariate analyses. CONCLUSIONS A GPS of 1 or 2 is a significant risk factor for postoperative morbidity and a prognostic factor for long-term survival.
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Massaut E, Hendlisz B, Klastersky JA. The close interrelation between colorectal cancer, infection and microbiota. Curr Opin Oncol 2020; 31:362-367. [PMID: 31090550 DOI: 10.1097/cco.0000000000000543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Evaluate the recent literature about the relation of clinical infection and colorectal cancer in terms of diagnosis of an occult infection and possible impact on oncological outcome and review the possible role of the gut microbiota in the role of colorectal cancer oncogenesis. RECENT FINDINGS Data published within the 2 last years have been reviewed and the conclusions, mostly supporting previously published information, have been critically discussed. SUMMARY Infection (bacteremia, cellulitis) might be a surrogate of occult colorectal cancer and postoperative infection complications might jeopardize long-term survival after potentially curative surgery. The role of the gut microbiota in the genesis of colorectal cancer remains an exciting though unresolved question.
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Affiliation(s)
- Edouard Massaut
- Service de Chirurgie, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Barbara Hendlisz
- Service d'Oncologie Médicale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean A Klastersky
- Service d'Oncologie Médicale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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23
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Katsuno H, Hanai T, Masumori K, Koide Y, Ashida K, Matsuoka H, Tajima Y, Endo T, Mizuno M, Cheong Y, Maeda K, Uyama I. Robotic Surgery for Rectal Cancer: Operative Technique and Review of the Literature. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:14-24. [PMID: 32002472 PMCID: PMC6989125 DOI: 10.23922/jarc.2019-037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
The number of patients undergoing robotic surgery for rectal cancer has rapidly increased in Japan, since the government approved the procedure for national insurance coverage in April 2018. Robotic surgery has the potential to overcome some limitations of laparoscopic surgery, especially in the narrow pelvis, providing a three-dimensional view, articulated instruments, and a stable camera platform. Although meta-analyses and randomized controlled trials have failed to demonstrate the superiority of robotic surgery over laparoscopic surgery with respect to the short-term clinical outcomes, the published findings suggest that robotic surgery may be potentially beneficial for patients who are obese, male, or patients undergoing sphincter-preserving surgery for rectal cancer. The safety and feasibility of robotic surgery for lateral lymph node dissection, the standard procedure for locally advanced lower rectal cancer in Japan, have been demonstrated in some retrospective studies. However, additional prospective, randomized trials are required to determine the actual benefits of robotic surgery to ameliorate the urogenital and oncological outcomes. The cost of this approach is a long-standing principal concern. A literature search showed that the cost of robotic surgery for rectal cancer was 1.3-2.5 times higher per patient than that for the laparoscopic approach. We herein describe our surgical technique using a da Vinci Surgical System (S/Si/Xi) with 10 years of experience in performing robotic surgery. We also review current evidence regarding short-term clinical and long-term oncological outcomes, lateral lymph node dissection, and the cost of the procedure.
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Affiliation(s)
- Hidetoshi Katsuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yoshikazu Koide
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Keigo Ashida
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yosuke Tajima
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Masahiro Mizuno
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yeongcheol Cheong
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
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