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Published in: Journal of Gastrointestinal Surgery 11/2023

22-09-2023 | Original Article

Delayed-Onset Organ/Space Surgical Site Infection Worsens Prognosis in High-Risk Stage II and III Colorectal Cancer

Authors: Jun Okui, Kohei Shigeta, Yujin Kato, Shodai Mizuno, Kiyoaki Sugiura, Yuki Seo, Jumpei Nakadai, Hideo Baba, Hiroto Kikuchi, Akira Hirata, Akitsugu Makino, Takayuki Kondo, Shimpei Matsui, Ryo Seishima, Koji Okabayashi, Hideaki Obara, Yasunori Sato, Yuko Kitagawa

Published in: Journal of Gastrointestinal Surgery | Issue 11/2023

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Abstract

Background

It is unclear how early- and delayed-onset organ/space surgical site infections (SSIs) affect the long-term prognosis of patients with colorectal cancer, who are potential candidates for adjuvant chemotherapy. This study aimed to investigate the association between the timing of SSI onset and clinical outcome.

Methods

This retrospective, multicenter cohort study evaluated patients who were diagnosed with high-risk stage II or III colorectal cancer and underwent elective surgery between 2010 and 2020. Five-year recurrence-free survival (RFS) was the primary endpoint and was compared between early SSI, delayed SSI (divided based on the median date of SSI onset), and non-SSI groups.

Results

A total of 2,065 patients were included. Organ/space SSI was diagnosed in 91 patients (4.4%), with a median onset of 6 days after surgery. The early-onset SSI group had a higher proportion of patients with Clavien–Dindo grade ≥IIIb SSI than the delayed-onset SSI. Patients who received adjuvant chemotherapy (AC) had earlier organ/space SSI onset than those who did not. The adjusted hazard ratio of 5-year RFS in the delayed-onset SSI was 2.58 (95% confidence interval: 1.43–4.65; p = 0.002): higher than that in the early-onset SSI, with the non-SSI as the reference.

Conclusions

Delayed-onset organ/space SSI worsened long-term prognosis compared to early-onset, and this may be due to delayed initiation of AC. Patients who are clinically suspected of having lymph node metastasis might need additional intervention to prevent delays in commencing AC due to the delayed SSI.
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Metadata
Title
Delayed-Onset Organ/Space Surgical Site Infection Worsens Prognosis in High-Risk Stage II and III Colorectal Cancer
Authors
Jun Okui
Kohei Shigeta
Yujin Kato
Shodai Mizuno
Kiyoaki Sugiura
Yuki Seo
Jumpei Nakadai
Hideo Baba
Hiroto Kikuchi
Akira Hirata
Akitsugu Makino
Takayuki Kondo
Shimpei Matsui
Ryo Seishima
Koji Okabayashi
Hideaki Obara
Yasunori Sato
Yuko Kitagawa
Publication date
22-09-2023
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 11/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-023-05836-0

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