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Ren LF, Xu YH, Long JG. Prognostic Value of Postoperative Complication for Gastric Cancer. J Laparoendosc Adv Surg Tech A 2024; 34:339-353. [PMID: 38573161 DOI: 10.1089/lap.2023.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Background: The incidence of complications in gastric cancer (GC) patients after surgery was increasing, and it was not clear whether postoperative complications would have an impact on prognosis. The current study attempted to investigate the role of postoperative complication for prognosis on GC patients undergoing radical resection. Materials and Methods: Eligible studies were searched in three databases, including PubMed, Embase, and the Cochrane Library, in accordance with the searching strategy on September 4th, 2022. The survival values were most concerned; then, hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled up. All prognostic values, including overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), and recurrence-free survival (RFS), were allowed. Subgroup analysis based on complication types was used for further in-depth research. Results: A total of 29 studies involving 33,858 patients were included in this study. Intra-abdominal abscess (19.4%) was the most common complications in the included studies, followed by anastomotic leakage (17.0%) and pneumonia (16.4%). There were 23, 4, 6, and 10 studies that reported OS, DFS, DSS, and RFS, respectively. After analysis, postoperative complication was found to be an independent prognostic factor for OS (HR = 1.52, I2 = 1.14%, 95% CI = 1.42-1.61, P = .00), DFS (HR = 1.71, I2 = 0.00%,95% CI = 1.44-1.98, P < .05), DSS (HR = 1.60, I2 = 54.58%, 95% CI = 1.26-1.93, P < .1), and RFS (HR = 1.26, I2 = 0.00%, 95% CI = 1.11-1.41, P < .05). Subgroup analysis found that noninfectious complication was not significantly associated with OS (HR = 1.39, I2 = 0.00%, 95% CI = 0.96-1.82, P > .05). Conclusion: Surgeons needed to pay more attention to GC patients who developed postoperative complications, especially infectious complications, and take proactive management to improve the prognosis.
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Affiliation(s)
- Lin-Fei Ren
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Yong-Hong Xu
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie-Gen Long
- Department of General Surgery, Affiliated Banan Hospital of Chongqing Medical University, Chongqing, China
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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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Choi Y, Lichterman JN, Coughlin LA, Poulides N, Li W, Del Valle P, Palmer SN, Gan S, Kim J, Zhan X, Gao Y, Evers BM, Hooper LV, Pasare C, Koh AY. Immune checkpoint blockade induces gut microbiota translocation that augments extraintestinal antitumor immunity. Sci Immunol 2023; 8:eabo2003. [PMID: 36867675 PMCID: PMC10080670 DOI: 10.1126/sciimmunol.abo2003] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
Gut microbiota, specifically gut bacteria, are critical for effective immune checkpoint blockade therapy (ICT) for cancer. The mechanisms by which gut microbiota augment extraintestinal anticancer immune responses, however, are largely unknown. Here, we find that ICT induces the translocation of specific endogenous gut bacteria into secondary lymphoid organs and subcutaneous melanoma tumors. Mechanistically, ICT induces lymph node remodeling and dendritic cell (DC) activation, which facilitates the translocation of a selective subset of gut bacteria to extraintestinal tissues to promote optimal antitumor T cell responses in both the tumor-draining lymph nodes (TDLNs) and the primary tumor. Antibiotic treatment results in decreased gut microbiota translocation into mesenteric lymph nodes (MLNs) and TDLNs, diminished DC and effector CD8+ T cell responses, and attenuated responses to ICT. Our findings illuminate a key mechanism by which gut microbiota promote extraintestinal anticancer immunity.
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Affiliation(s)
- Yongbin Choi
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Jake N. Lichterman
- Division of Hematology/Oncology, Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Laura A. Coughlin
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Nicole Poulides
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Wenling Li
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Priscilla Del Valle
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Department of Cell and Molecular Biology, The University of Texas Southwestern Medical Center, Dallas, TX. 75390
| | - Suzette N. Palmer
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Department of Biomedical Engineering, The University of Texas Southwestern Medical, Dallas, TX 75390
| | - Shuheng Gan
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Jiwoong Kim
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Xiaowei Zhan
- Department of Population and Data Sciences, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Yajing Gao
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Bret M. Evers
- Department of Pathology, The University of Texas Southwestern Medical, Dallas, TX 75390
| | - Lora V. Hooper
- Department of Immunology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- The Howard Hughes Medical Institute, The University of Texas Southwestern Medical Center, Dallas, TX 75390
| | - Chandrashekhar Pasare
- Division of Immunobiology and Center for Inflammation and Tolerance, Cincinnati Children’s Hospital Medical Center Cincinnati, OH 45229
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH 45220
| | - Andrew Y. Koh
- Department of Pediatrics, Division of Hematology/Oncology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Harold C. Simmons Comprehensive Cancer Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390
- Department of Microbiology, The University of Texas Southwestern Medical Center, Dallas, TX 75390
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Are Postoperative Infections in the First 12 Months after Wide Resection and Megaprosthetic Replacement Associated with the Survival of Osteosarcoma Patients? Results of a Multicenter Study. Cancers (Basel) 2022; 14:cancers14112682. [PMID: 35681660 PMCID: PMC9179350 DOI: 10.3390/cancers14112682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Postoperative infection is one of the gravest complications in patients following megaprosthetic replacement due to primary malignant bone tumors. On the other hand, several studies have also suggested that patients with a variety of different cancers may have a better chance of survival following the development of an infection, possibly as a result of the immune and inflammatory host responses to infection. Our retrospective analysis of 437 extremity osteosarcoma patients found that patients with a poor response to neoadjuvant chemotherapy and an infection in the first 12 months after primary tumor surgery had a better chance of survival compared to patients without infections. If this finding can be validated in a different patient cohort, it would suggest that the efficacy of novel immunomodulatory treatments in osteosarcoma patients should be evaluated and reported separately for patients with a good and a poor response to preoperative chemotherapy, as the latter might benefit more from such treatments. Abstract Recent retrospective studies suggested that early postoperative infections might be associated with a survival benefit for extremity osteosarcoma patients, but the reported results have been conflicting. The files of 437 patients with a newly diagnosed, high-grade osteosarcoma of the extremities treated at 5 referral centers in Germany and Austria between 1989 and 2016 were retrospectively evaluated. All patients underwent multi-agent chemotherapy and limb-sparing tumor excision, followed by endoprothetic replacement. We used the Kaplan–Meier method to calculate survival curves, which we compared with the log-rank test. With a median follow-up of 100 months (interquartile range, 49–155 months), local recurrence (LR) probability, event-free survival (EFS), and disease-specific survival (DSS) after 5 years in this selected patient cohort amounted to 5%, 67%, and 79%, respectively, and 46 patients (10.5%) developed an early postoperative infection. We found no significant differences in LR, EFS, or DSS between patients with and without early infections, and there were no differences in known prognostic factors between the two groups. However, in subgroup analyses patients with a poor response to neoadjuvant chemotherapy and an early infection had a better DSS compared to patients without early infections (93% vs. 62% after 5 years, p = 0.044). Provided that our findings can be validated in separate patient cohorts, we believe that patient outcome after adjuvant immunomodulatory treatments in osteosarcoma patients should be evaluated and reported separately for good and poor responders to neoadjuvant chemotherapy in future studies.
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Davies JC, Hugh S, Rich JT, de Almeida JR, Gullane PJ, Orsini M, Eskander A, Monteiro E, Mimica X, McGill M, Cohen MA, Cracchiolo JR, Teaima A, Tam S, Wei D, Goepfert R, Zafereo M, Su J, Xu W, Goldstein DP. Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy: A Multicenter Collaborative Cohort Study. JAMA Otolaryngol Head Neck Surg 2021; 147:1027-1034. [PMID: 34323968 DOI: 10.1001/jamaoto.2021.1545] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain. Objective To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival. Design, Setting, and Participants A multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years). Main Outcomes and Measures Outcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years. Results In all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, -6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, -2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, -4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control. Conclusions and Relevance This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.
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Affiliation(s)
- Joel C Davies
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Hugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason T Rich
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - John R de Almeida
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mario Orsini
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Head & Neck Cancer Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Head & Neck Cancer Care, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Mt Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ximena Mimica
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marlena McGill
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Head & Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ahmed Teaima
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Samantha Tam
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Dongmin Wei
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Ryan Goepfert
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Mark Zafereo
- Department of Head & Neck Surgery, Division of Surgery, MD Anderson Cancer Center, The University of Texas, Houston
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Han WH, Oh YJ, Eom BW, Yoon HM, Kim YW, Ryu KW. Prognostic impact of infectious complications after curative gastric cancer surgery. Eur J Surg Oncol 2020; 46:1233-1238. [PMID: 32362466 DOI: 10.1016/j.ejso.2020.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION There have been few studies about the effect of infectious complications on recurrence or long-term survival outcome after curative gastric cancer surgery in large populations. This study was conducted to investigate the impact of infectious complications on long-term survival after curative gastrectomy in high volume center. METHOD From January 2002 to December 2012, patients who underwent curative gastrectomy were enrolled. Infectious complications were defined as wound infection, intra-abdominal infection or postoperative pneumonia. Five-year overall survival was compared between two groups and followed by multivariable analysis using a Cox proportional hazards model. RESULT Of 6585 patients who underwent curative gastrectomy, 413 (6.2%) had infectious complications after curative gastrectomy. The five-year overall survival rate was 86.0% in non-complication patients and 74.1% in infectious complications patients (P < 0.001). In univariate analysis, Age over 70 years, male sex, higher ASA score, total or proximal gastrectomy, advanced stage and infectious complication had statistically worse survival. A Cox proportional hazards model indicated that the infectious complication was independent prognostic factor (HR = 1.478, CI 95% 1.242-1.757 p < 0.001) as well as age over 70 years (HR = 2.434, CI 95% 2.168-2.734 p < 0.001), male sex (HR = 1.153, CI 95% 1.022-1.302 p = 0.014), higher ASA score (p < 0.001) and advanced Stage (p < 0.001). Local recurrence (P = 0.044), LN recurrence (P = 0.038) and hematologic recurrence (P = 0.033) were significantly associated with infectious complications. CONCLUSION Postoperative infectious complication was an independent prognostic factor for five-year overall survival after curative gastrectomy as well as known factors. A significant association between infectious complications and recurrence were also noted. The surgeon should try to prevent the infectious complications in gastric cancer surgery to improve the long term survival.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea
| | - Yoon Jung Oh
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, 410-769, South Korea.
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de Almeida JR, Yao CM, Ziai H, Staibano P, Huang SH, Hosni A, Hope A, Bratman SV, Monteiro E, Gilbert RW, Brown DH, Gullane PJ, Irish JC, Su J, Xu W, Goldstein DP. Postoperative wound infections, neutrophil-to-lymphocyte ratio, and cancer recurrence in patients with oral cavity cancer undergoing surgical resection. Oral Oncol 2019; 97:23-30. [DOI: 10.1016/j.oraloncology.2019.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 07/24/2019] [Indexed: 12/17/2022]
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Behnke NK, Alamanda VK, Song Y, Archer KR, Halpern JL, Schwartz HS, Holt GE. Does postoperative infection after soft tissue sarcoma resection affect oncologic outcomes? J Surg Oncol 2013; 109:415-20. [PMID: 24284805 DOI: 10.1002/jso.23518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/09/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Prior studies have demonstrated postoperative infection may confer a survival benefit after osteosarcoma resection. Our aim was to determine whether infection after soft tissue sarcoma resection has similar effects on metastasis, recurrence and survival. METHODS A retrospective review was conducted; 396 patients treated surgically for a soft tissue sarcoma between 2000 and 2008 were identified. Relevant oncologic data were collected. Fifty-six patients with a postoperative infection were compared with 340 patients without infection. Hazard ratios and overall cumulative risk were evaluated. RESULTS There was no difference in survival, local recurrence or metastasis between patients with or without a postoperative infection. Patients were evenly matched for age at diagnosis, gender, smoking status, and diabetes status. Tumor characteristics did not differ between groups in tumor size, location, depth, grade, margin status, stage, and histologic subtype. There was no difference in utilization of chemotherapy or radiation therapy between groups. From our competing risk model, only positive margin status significantly impacted the risk of local recurrence. An increase in tumor size corresponded to an increased risk of metastasis and death. CONCLUSIONS Postoperative infection neither conferred a protective effect, nor increased the risk of adverse oncologic outcomes after soft tissue sarcoma resection.
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Affiliation(s)
- Nicole K Behnke
- Division of Orthopaedic Surgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama
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9
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Ch'ng S, Choi V, Elliott M, Clark JR. Relationship between postoperative complications and survival after free flap reconstruction for oral cavity squamous cell carcinoma. Head Neck 2013; 36:55-9. [PMID: 23559547 DOI: 10.1002/hed.23266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Current literature on the effect of postoperative complications on survival outcomes in head and neck cancers remains contradictory. This study assesses whether postoperative complications adversely affect survival in cases of complex surgical ablation and reconstruction of oral squamous cell carcinoma. METHODS In all, 255 consecutive patients with complete clinicopathologic data were included. Survival was determined using the log-rank test and Kaplan-Meier survival curves were generated. A Cox proportional hazards model was used to adjust for the effect of other significant covariates to determine the independent effect of complication variables for overall survival (OS). A competing risk model was used for disease-specific survival (DSS). RESULTS On multivariable analysis, major complications independently prognosticated for reduced OS [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.1-3.2, p = .02]. There was no evidence for an association between any complication-variable and DSS or recurrence. CONCLUSIONS Major postoperative complications are independently associated with decreased OS.
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Affiliation(s)
- Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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González-Márquez R, Rodrigo JP, Suárez Nieto C. Prognostic significance of postoperative wound infections after total laryngectomy. Head Neck 2011; 34:1023-7. [PMID: 22025258 DOI: 10.1002/hed.21866] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In oncologic surgery, the relationship between postoperative wound infections and prognosis remains unclear. The purpose of this study was to establish the prognostic significance of surgical wound infections in laryngectomized patients. METHOD We studied 129 consecutive patients with previously untreated laryngeal or hypopharyngeal squamous cell carcinoma who underwent a total laryngectomy. Minimum follow-up was 24 months. RESULTS Fifty-seven patients (44%) developed a wound infection. Infections were more frequent in hypopharyngeal tumors (p < .001). Surgical wound infection was associated with a worse disease-specific survival (p = .046), but this association was due to the hypopharyngeal subgroup of cases (p = .024). In multivariate analysis, the only parameters significantly associated with a worse disease-specific survival in these cases were nodal extracapsular invasion (p < .001) and surgical wound infection (p = .02). CONCLUSION Our results suggest that the development of a postoperative wound infection is a poor prognostic sign in patients with advanced hypopharyngeal cancers surgically treated.
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Affiliation(s)
- Rocío González-Márquez
- Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain.
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11
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Lee JA, Kim MS, Kim DH, Lim JS, Park KD, Cho WH, Song WS, Lee SY, Jeon DG. Postoperative infection and survival in osteosarcoma patients. Ann Surg Oncol 2008; 16:147-51. [PMID: 18979137 DOI: 10.1245/s10434-008-0184-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 08/31/2008] [Accepted: 09/01/2008] [Indexed: 12/25/2022]
Abstract
The clinical impact of postoperative deep infection on survival remains controversial in osteosarcoma patients. The authors identified 31 osteosarcoma patients that developed a deep infection within 1 year of operation between 1990 and 2003, and compared clinicopathologic characteristics of 31 patients that developed an infection with those of 316 patients that did not. For survival analysis, 62 noninfected patients matched for prognostic factors such as histologic response, tumor size, and location were also selected. In infected patients, although it was not significant due to the small patient numbers, good response to preoperative chemotherapy and a proximal tibial location were frequently observed. No local recurrence developed in infected patients. Five-year overall and metastasis-free survival rates for the 31 infected patients were as high as 89% and 73%, respectively. However, after matching for clinical factors, no survival difference was noted between infected and noninfected patients. Deep infection has a multifaceted effect on patients. However, the present study suggests that the reported positive effect on survival is likely to be related to the clinical characteristics of infected patients rather than an antitumor effect due to the infection. Further investigations are needed to clarify the precise effects of infection.
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Affiliation(s)
- Jun Ah Lee
- Department of Pediatrics, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul, 139-706, South Korea
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12
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Murthy BL, Thomson CS, Dodwell D, Shenoy H, Mikeljevic JS, Forman D, Horgan K. Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 2007; 97:1211-7. [PMID: 17968426 PMCID: PMC2360477 DOI: 10.1038/sj.bjc.6604004] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Many factors involved in wound healing can stimulate tumour growth in the experimental setting. This study examined the relationship between wound complications and the development of systemic recurrence after treatment of primary breast cancer. One thousand and sixty-five patients diagnosed with operable primary invasive breast cancer between 1994 and 2001 were assessed for development of systemic recurrence according to whether or not a wound complication occurred after surgery, with a median follow-up of 54 months (range 15–119). There were 93 wound complications (9%). There was a statistically significant greater risk of developing systemic recurrence in patients with wound problems than those without (hazard ratio (HR) 2.87; 95% CI: 1.97, 4.18; P<0.0001). This remained in a multivariate analysis after adjustment for case mix variables, including Nottingham Prognostic Index (NPI) and oestrogen–progesterone receptor status (HR: 2.52; 95% CI: 1.69, 3.77; P<0.0001). In the good prognostic NPI group, 4 out of 27 patients (15%) with wound problems vs 11 out of 334 (3%) without wound problems developed systemic recurrence. The corresponding figures were 10 out of 35 (29%) vs 48 out of 412 (12 %) in the moderate prognostic group and 18 out of 29 (62%) vs 75 out of 199 (38%) in the poor prognostic group. In 29 patients NPI could not be calculated. Smokers at the time of diagnosis were more likely to develop metastatic disease than the non-smokers (HR: 1.50; 95% CI: 1.04, 2.15; P=0.03) after adjustment for other factors. The results suggest that patients with wound complications at primary surgery have increased rates of systemic recurrence of breast cancer.
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Affiliation(s)
- B L Murthy
- Department of Surgery, The General Infirmary at Leeds, Leeds LS1 3EX, UK
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Jeys LM, Grimer RJ, Carter SR, Tillman RM, Abudu A. Post Operative Infection and Increased Survival in Osteosarcoma Patients: Are They Associated? Ann Surg Oncol 2007; 14:2887-95. [PMID: 17653803 DOI: 10.1245/s10434-007-9483-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 05/11/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite neo-adjuvant chemotherapy osteosarcomas having significant mortality, recent studies have shown survival advantages following infections for some tumour types. This study investigates the effect of post-operative infection in patients treated for osteosarcoma using endoprosthetic replacement and neo-adjuvant chemotherapy. MATERIAL AND METHODS A consecutive series of 547 patients underwent surgery between 1981 and 2001 for osteosarcoma. Patients were excluded from the study if over 60 years old at diagnosis (n = 14) as they would not routinely receive chemotherapy. Studies showed that 70% of deep infections occur within one year from reconstruction. Therefore landmark analysis was performed; all patients infected after 12 months of reconstruction were excluded (15 patients, 2.7%) and those who died within 12 months from diagnosis due to metastases were excluded (105 patients, 19.2%), leaving 412 patients. Any survival advantage of early infection was analysed by Kaplan-Meier survival analysis from this landmark point. RESULTS Overall population survival was 65% at 10 years after landmarking. There were 41 patients (10%) who developed an infection within one year of implantation. These patients had significantly better survival (p = 0.017). The 10-year survival for patients with osteosarcoma with infection was 84.5% compared to 62.3% in the non-infected group after landmarking. There was no significant difference in the percentage post-chemotherapy specimen necrosis between the two groups (p = 0.36). Infection was an independent prognostic factor on cox regression analysis. CONCLUSIONS There was evidence for increased survival after deep post-operative infection in osteosarcoma patients, in keeping with other research. The authors feel this warrants further investigation.
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Affiliation(s)
- L M Jeys
- Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP, United Kingdom.
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Liptak JM, Dernell WS, Ehrhart N, Lafferty MH, Monteith GJ, Withrow SJ. Cortical allograft and endoprosthesis for limb-sparing surgery in dogs with distal radial osteosarcoma: a prospective clinical comparison of two different limb-sparing techniques. Vet Surg 2006; 35:518-33. [PMID: 16911152 DOI: 10.1111/j.1532-950x.2006.00185.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare surgical and oncologic outcome in dogs with osteosarcoma (OSA) of the distal aspect of the radius treated with limb-sparing surgery, using either a cortical allograft or endoprosthesis, and postoperative chemotherapy; and to evaluate predictive factors for outcome. STUDY DESIGN Prospective cohort study. ANIMALS Dogs (n = 20) with spontaneous, non-metastatic OSA of the distal aspect of the radius. METHODS Dogs were prospectively randomized for limb-sparing surgery with either a cortical allograft (n = 10) or endoprosthesis (10) and full-course adjuvant chemotherapy using single or dual agent protocols of cisplatin, carboplatin, and/or doxorubicin. Surgical (intraoperative findings, postoperative infection, construct failure) and oncologic (local tumor recurrence, metastasis, survival) outcomes were compared. The influence of intraoperative and postoperative variables on surgical and oncologic outcome were evaluated. RESULTS No clinically significant differences in surgical and oncologic outcome were detected between groups. The percentage of radius replaced by the implant was significantly greater in the endoprosthesis group (60.9% compared with 48.6%, P = .008). Median survival time (MST) for dogs with construct failure, regardless of implant type, was 685 days and significantly greater than MST of dogs without construct failure (322 days, P = .042; hazard ratio [HR] 16.82). Median metastasis-free interval and MST (685 days versus 289 days; P = .034, HR 24.58) were significantly greater in dogs with postoperative infection. Disease-free and overall limb-salvage rates were 70% and 85%, respectively. Overall MST was 430 days. CONCLUSIONS For dogs with OSA of the distal aspect of the radius, a cortical allograft or endoprosthesis can be used for limb-sparing surgery. Construct failure and postoperative infection significantly improve survival time regardless of implant type. CLINICAL RELEVANCE An endoprosthesis is an attractive alternative to cortical allografts for limb-salvage of the distal aspect of the radius in dogs because surgical and oncologic outcomes are similar, but the endoprosthesis is an immediately available off-the-shelf implant which is not complicated by the bone harvesting and banking requirements associated with cortical allografts. Mechanisms whereby postoperative infection improves survival time requires further investigation and, if elucidated, may provide the opportunity to improve the outcome of dogs and humans with OSA.
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Affiliation(s)
- Julius M Liptak
- Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA
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Lascelles BDX, Dernell WS, Correa MT, Lafferty M, Devitt CM, Kuntz CA, Straw RC, Withrow SJ. Improved Survival Associated With Postoperative Wound Infection in Dogs Treated With Limb-Salvage Surgery for Osteosarcoma. Ann Surg Oncol 2005; 12:1073-83. [PMID: 16252138 DOI: 10.1245/aso.2005.01.011] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 07/20/2005] [Indexed: 11/18/2022]
Abstract
BACKGROUND Limb-salvage surgery and adjuvant chemotherapy are performed as a treatment of appendicular osteosarcoma in dogs. Approximately 50% of dogs that undergo limb-salvage surgery develop postoperative surgical wound infections. Postoperative surgical infections may affect survival in cancer patients. The purposes of this study were to examine the effect of surgical wound infection on survival, local recurrence, and metastasis in relation to other prognostic factors for dogs with spontaneous osteosarcoma treated with limb-salvage surgery. METHODS Forty-seven client-owned dogs with osteosarcoma of the distal radius were treated with limb-salvage surgery and adjuvant chemotherapy--either carboplatin or carboplatin and doxorubicin. Hazard ratios were estimated by using the Cox proportional hazard model, and survival functions were estimated by using the Kaplan-Meier product-limit life-table method. RESULTS Of the 47 dogs in this study, 32 (68%) developed a postoperative wound infection. Infection, dog weight, and extent of the primary tumor (percentage of length) significantly affected survival, and infection and percentage of length significantly affected time to metastasis. None of the variables considered in this study affected local recurrence. Dogs that were diagnosed with an infection were less likely to die (hazard ratio, .446), and dogs with greater body weight and greater percentage length involvement were more likely to die (hazard ratios of 3.37 and 3.66, respectively). CONCLUSIONS In dogs with osteosarcoma treated with limb-salvage surgery, infection has a positive influence on survival, as does a smaller initial length of radius involved and lower body weight.
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Affiliation(s)
- B Duncan X Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27606, USA.
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Amar A, Miyahira L, Rapoport A, Franz SA. Significado prognóstico da deiscência e infecção da ferida operatória no carcinoma epidermóide das vias aerodigestivas superiores. Rev Col Bras Cir 2003. [DOI: 10.1590/s0100-69912003000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar o efeito da infecção e da deiscência da ferida operatória sobre o controle local do carcinoma epidermóide das vias aerodigestivas superiores, identificando fatores associados à ocorrência destas complicações. MÉTODO: Estudo retrospectivo de 239 pacientes com carcinoma epidermóide de boca, orofaringe e hipofaringe tratados cirurgicamente no Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia do Hospital Heliópolis entre 1990 e 1996, onde foram avaliados o hemograma e o proteinograma pré-operatório em relação ao risco de desenvolvimento de deiscência e infecção da ferida operatória e comparadas as taxas de recidiva local entre os pacientes com e sem deiscência/infecção da ferida operatória. RESULTADOS: A doença em estádio avançado (estádio IV) e a relação albumina/globulina inferior a 1,2 foram mais freqüentes entre os pacientes que desenvolveram deiscência/infecção (DI) da ferida operatória. A taxa de recidiva local foi de 49% nos pacientes que apresentaram DI e 42% naqueles sem DI. CONCLUSÃO: os pacientes com doença em estádio avançado e aqueles com relação albumina/globulina inferior a 1,2 apresentam maior risco de deiscência/infecção da ferida operatória. A presença de deiscência/infecção não apresentou relação com as taxas de recidiva local.
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Wenisch C, Werkgartner T, Sailer H, Patruta S, Krause R, Daxboeck F, Parschalk B. Effect of preoperative prophylaxis with filgrastim in cancer neck dissection. Eur J Clin Invest 2000; 30:460-6. [PMID: 10809907 DOI: 10.1046/j.1365-2362.2000.00643.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cancer surgery is known to lead to a deterioration in host defence mechanisms and an increase in susceptibility to infection after operation. Filgrastim enhances important antimicrobial functions of neutrophils including chemotaxis, phagocytosis and oxidative killing mechanisms. METHODS The effects of additional (all patients received perioperative 3 ' 25 mg kg-1 cefotiam and 1 ' 20 mg kg-1 metronidazole) preoperative prophylaxis with filgrastim (5 microg kg-1 12 h prior to surgery plus 5 microg kg-1 0 h prior to surgery) on neutrophil phagocytosis and reactive oxygen radical production and postoperative infections in 24 patients undergoing cancer neck dissection were studied. Phagocytic capacity was assessed by measuring the uptake of fluorescein isothiocyanate-labelled Escherichia coli and Staphylococcus aureus by flow cytometry. Reactive oxygen generation after phagocytosis was estimated by determining the amount of dihydrorhodamine 123 converted to rhodamine 123, intracellularly. RESULTS In the filgrastim-treated patients a higher neutrophil phagocytic capacity was seen intraoperatively, and 1-5 days postoperative, but not prior to surgery. Reactive oxygen radical production was significantly higher in filgrastim-treated patients prior to surgery, intraoperative and postoperative (1-5 days). 2/12 (17%) patients had postoperative infections in the filgrastim group and 9/12 (75%) patients had infections in the placebo group (P < 0.001). In particular, wound infections were recorded more often in the placebo group (1/12 vs. 6/12; P = 0.004). CONCLUSION We conclude that filgrastim enhances perioperative neutrophil function and could be useful in the prophylaxis of postoperative wound infections in patients undergoing cancer neck dissection.
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Affiliation(s)
- C Wenisch
- University Hospital of Vienna, Vienna, Austria.
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van Bokhorst-de van der Schueren MAE, van Leeuwen PAM, Kuik DJ, Klop WMC, Sauerwein HP, Snow GB, Quak JJ. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 1999. [DOI: 10.1002/(sici)1097-0142(19990801)86:3<519::aid-cncr22>3.0.co;2-s] [Citation(s) in RCA: 213] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Rodrigo JP, Suárez C. Prognostic significance of postoperative wound infection on head and neck cancer. Otolaryngol Head Neck Surg 1998; 118:272-5. [PMID: 9482566 DOI: 10.1016/s0194-5998(98)80030-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prognostic significance of wound infections after surgery for squamous cell carcinoma of the head and neck is controversial. We retrospectively studied the relationship between wound infection, tumor recurrence, and survival rates in 158 patients operated on for supraglottic cancer. All patients had 3-year follow-up. Wound infection developed in 14 patients (8.8%). The overall recurrence rate was 29.7%. For those in whom a wound infection developed the recurrence rate was 57%, compared with 27% for those in whom no such infection developed (p = 0.041). Disease-free survival was also adversely affected in the group of patients with infections, although because of the limited number of patients the differences did not reach statistical significance. We conclude that postoperative wound infection may have an adverse effect on prognosis in squamous cell carcinomas of the head and neck.
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Affiliation(s)
- J P Rodrigo
- Department of Otolaryngology, Hospital Central de Asturias, University of Oviedo, Spain
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Grandis JR, Snyderman CH, Johnson JT, Yu VL, D'Amico F. Postoperative wound infection. A poor prognostic sign for patients with head and neck cancer. Cancer 1992; 70:2166-70. [PMID: 1394047 DOI: 10.1002/1097-0142(19921015)70:8<2166::aid-cncr2820700826>3.0.co;2-h] [Citation(s) in RCA: 62] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The development of a wound infection has been identified as a favorable prognostic factor after oncologic surgical procedures. METHODS The authors retrospectively studied the relationship between postoperative wound infection, local/regional tumor recurrence, and survival rates in 134 patients undergoing therapeutic surgical resection for squamous cell carcinoma of the head and neck (SCCHN). RESULTS The median age was 61 years (range, 25-87 years) with most (75%) patients having advanced disease (Stage III or IV). Patients without evidence of recurrent disease were followed up for a median time of 34 months (range, 24-68 months). Twenty-nine (22%) had local or regional bacterial infections develop postoperatively. Recurrence rates were increased (P = 0.008) in patients with postoperative wound infections compared with patients who had distant infections, e.g., pneumonia or urinary tract infection, or no infection. Disease-free survival also was adversely affected (P = 0.04) in this group. Both advanced tumor stage and postoperative wound infections were independently associated with decreased survival, with odds ratios of 2:3 and 2:4, respectively. CONCLUSIONS These data contrast with other reports in the literature of a beneficial effect of postoperative wound infection on outcome. These findings suggest a possible relationship between local/regional immune function and postoperative infection in patients with SCCHN:
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Affiliation(s)
- J R Grandis
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania
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