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International Journal of Colorectal Disease

Published in:

01-04-2016 | Original Article

Malignancy is a risk factor for postoperative infectious complications after elective colorectal resection

Authors: Thibault Crombe, Jérôme Bot, Mathieu Messager, Vianney Roger, Christophe Mariette, Guillaume Piessen

Published in: International Journal of Colorectal Disease | Issue 4/2016

Abstract

Purpose

Patient and technical factors influencing the postoperative infectious complications (ICs) after elective colorectal resections are satisfactorily described. However, the underlying disease-related factors have not been extensively evaluated. This study aimed to measure the effect of malignancy on postoperative surgical site and extra surgical site infections after elective colorectal resection.

Methods

This study is a bicentric retrospective matched pair study of prospectively gathered data. Between 2004 and 2013, 1104 consecutive patients underwent colorectal resection in two centers. Patients undergoing elective resection with supraperitoneal anastomosis for benign diseases (excluding inflammatory bowel disease) (group B, n = 305) were matched to randomly selected patients with malignancy (group M, n = 305). The matching variables were age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, type of resection, and surgical approach. We compared the 30-day IC rates between patients with benign diseases (group B) and malignancy (group M). Multivariate logistic regression analysis was performed to identify the risk factors for ICs.

Results

Group M had a higher overall rate of IC (25.6 vs 16.1 %, P = 0.004) as well as a higher risk of extra surgical site infections (P = 0.007) and anastomotic leakage (P = 0.039). The independent risk factors for ICs were malignancy (odds ratio (OR) = 2.02; P = 0.002), age ≥70 years (OR = 1.73, P = 0.018), tobacco history (OR = 1.87; P = 0.030), and obesity (OR = 1.68; P = 0.039).

Conclusion

Malignancy, age, tobacco history, and obesity increase the risk of ICs after colorectal resection. Improvement of the modifiable risk factors, increased compliance with an enhanced recovery after surgery (ERAS) program in the overall population, and optimization of immune function in patients with malignancy should be considered.

Pendlimari R, Cima RR, Wolff BG, Pemberton JH, Huebner M (2012) Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs? J Am Coll Surg 214:574–580. doi:10.1016/j.jamcollsurg.2011.12.023 CrossRefPubMed

Rovera F, Dionigi G, Boni L, Piscopo C, Masciocchi P, Alberio MG, Carcano G, Diurni M, Dionigi R (2007) Infectious complications in colorectal surgery. Surg Oncol 16(Suppl 1):S121–S124CrossRefPubMed

Reddy KM, Meyer CE, Palazzo FF, Conaghan P, Blunt MC, Stebbings WS, Leicester RJ, Cullen PT (2003) Postoperative stay following colorectal surgery: a study of factors associated with prolonged hospital stay. Ann R Coll Surg Engl 85:111–114CrossRefPubMedPubMedCentral

Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH (2015) Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg 261:497–505. doi:10.1097/SLA.0000000000000854 CrossRefPubMed

Young H, Knepper B, Moore EE, Johnson JL, Mehler P, Price CS (2012) Surgical site infection after colon surgery: National Healthcare Safety Network risk factors and modeled rates compared with published risk factors and rates. J Am Coll Surg 214:852–859. doi:10.1016/j.jamcollsurg.2012.01.041 CrossRefPubMed

Piessen G, Muscari F, Rivkine E, Sbaï-Idrissi MS, Lorimier G, Fingerhut A, Dziri C, Hay JM, FRENCH (Fédération de Recherche EN CHirurgie) (2011) Prevalence of and risk factors for morbidity after elective left colectomy: cancer vs noncomplicated diverticular disease. Arch Surg 146:1149–1155. doi:10.1001/archsurg.2011.231 CrossRefPubMed

Biondo S, Kreisler E, Fraccalvieri D, Basany EE, Codina-Cazador A, Ortiz H (2012) Risk factors for surgical site infection after elective resection for rectal cancer. A multivariate analysis on 2131 patients. Color Dis 14:e95–e102. doi:10.1111/j.1463-1318.2011.02798.x CrossRef

Ishikawa M, Nishioka M, Hanaki N, Miyauchi T, Kashiwagi Y, Ioki H, Kagawa A, Nakamura Y (2009) Perioperative immune responses in cancer patients undergoing digestive surgeries. World J Surg Oncol 7:7. doi:10.1186/1477-7819-7-7 CrossRefPubMedPubMedCentral

Bot J, Piessen G, Robb WB, Roger V, Mariette C (2013) Advanced tumor stage is an independent risk factor of postoperative infectious complications after colorectal surgery: arguments from a case-matched series. Dis Colon Rectum 56:568–576. doi:10.1097/DCR.0b013e318282e790 CrossRefPubMed

10.

Suding P, Jensen E, Abramson MA, Itani K, Wilson SE (2008) Definitive risk factors for anastomotic leaks in elective open colorectal resection. Arch Surg 143:907–11. doi:10.1001/archsurg.143.9.907 CrossRefPubMed

11.

Poon JT, Law WL, Wong IW, Ching PT, Wong LM, Fan JK, Lo OS (2009) Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg 249:77–81. doi:10.1097/SLA.0b013e31819279e3 CrossRefPubMed

12.

Thesaurus National de Cancérologie Digestive– chapitre 3: Cancer du colon. http://www.TNCD.org. Accessed 22 Dec 2015

13.

Société française d’anesthésie et de réanimation (2011) Antibioprophylaxis in surgery and interventional medicine (adult patients). Actualization 2010. Ann Fr Anesth Reanim 30:168–190. doi:10.1016/j.annfar.2010.05.012 CrossRef

14.

Gendall KA, Raniga S, Kennedy R, Frizelle FA (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237CrossRefPubMed

15.

Tekkis PP, Prytherch DR, Kocher HM, Senapati A, Poloniecki JD, Stamatakis JD, Windsor AC (2004) Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM). Br J Surg 91:1174–1182CrossRefPubMed

16.

de Oliveira AC, Ciosak SI, Ferraz EM, Grinbaum RS (2006) Surgical site infection in patients submitted to digestive surgery: risk prediction and the NNIS risk index. Am J Infect Control 34:201–207CrossRefPubMed

17.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 20:271–274CrossRefPubMed

18.

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1988) CDC definitions for nosocomial infections, 1988. Am J Infect Control 16:128–140CrossRefPubMed

19.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

20.

Alves A, Panis Y, Mathieu P, Mantion G, Kwiatkowski F, Slim K, Association Française de Chirurgie (2005) Postoperative mortality and morbidity in French patients undergoing colorectal surgery: results of a prospective multicenter study. Arch Surg 140:278–283CrossRefPubMed

21.

Gervaz P, Bandiera-Clerc C, Buchs NC, Eisenring MC, Troillet N, Perneger T, Harbarth S (2012) Scoring system to predict the risk of surgical-site infection after colorectal resection. Br J Surg 99:589–595. doi:10.1002/bjs.8656 CrossRefPubMed

22.

Grønkjær M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, Becker U, Flensborg-Madsen T (2014) Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg 259:52–71. doi:10.1097/SLA.0b013e3182911913 CrossRefPubMed

23.

Sharma A, Deeb AP, Iannuzzi JC, Rickles AS, Monson JR, Fleming FJ (2013) Tobacco smoking and postoperative outcomes after colorectal surgery. Ann Surg 258:296–300. doi:10.1097/SLA.0b013e3182708cc5 CrossRefPubMed

24.

Cirocchi R, Trastulli S, Farinella E, Desiderio J, Vettoretto N, Parisi A, Boselli C, Noya G (2012) High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 21:e111–e123. doi:10.1016/j.suronc.2012.04.004 CrossRefPubMed

25.

Matsuda A, Furukawa K, Suzuki H, Kan H, Tsuruta H, Matsumoto S, Shinji S, Tajiri T (2007) Does impaired TH1/TH2 balance cause postoperative infectious complications in colorectal cancer surgery? J Surg Res 139:15–21CrossRefPubMed

26.

Heriot AG, Marriott JB, Cookson S, Kumar D, Dalgleish AG (2000) Reduction in cytokine production in colorectal cancer patients: association with stage and reversal by resection. Br J Cancer 82:1009–1012CrossRefPubMedPubMedCentral

27.

Ferri M, Rossi Del Monte S, Salerno G, Bocchetti T, Angeletti S, Malisan F, Cardelli P, Ziparo V, Torrisi MR, Visco V (2013) Recovery of immunological homeostasis positively correlates both with early stages of right-colorectal cancer and laparoscopic surgery. PLoS One 8:e74455. doi:10.1371/journal.pone.0074455 CrossRefPubMedPubMedCentral

28.

Donohoe CL, Feeney C, Carey MF, Reynolds JV (2011) Perioperative evaluation of the obese patient. J Clin Anesth 23:575–586. doi:10.1016/j.jclinane.2011.06.005 CrossRefPubMed

29.

Braga M, Vignali A, Zuliani W, Radaelli G, Gianotti L, Martani C, Toussoun G, Di Carlo V (2002) Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. Dis Colon Rectum 45:1070–1077CrossRefPubMed

30.

Hersey P, Prendergast D, Edwards A (2003) Effects of cigarette smoking on the immune system. Follow-up studies in normal subjects after cessation of smoking. Med J Aust 2:425–429

31.

Huang DD, Wang SL, Zhuang CL, Zheng BS, Lu JX, Chen FF, Zhou CJ, Shen X, Yu Z (2015) Sarcopenia, as defined by low muscle mass, strength and physical performance, predicts complications after colorectal cancer surgery. Color Dis. doi:10.1111/codi.13067

32.

Kartheuser AH, Leonard DF, Penninckx F, Paterson HM, Brandt D, Remue C, Bugli C, Dozois E, Mortensen N, Ris F, Tiret E, Waist Circumference Study Group (2013) Waist Circumference Study Group. Waist circumference and waist/hip ratio are better predictive risk factors for mortality and morbidity after colorectal surgery than body mass index and body surface area. Ann Surg 258:722–730. doi:10.1097/SLA.0b013e3182a6605a CrossRefPubMed

33.

Richards CH, Platt JJ, Anderson JH, McKee RF, Horgan PG, McMillan DC (2011) The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer. Ann Surg 254:83–89. doi:10.1097/SLA.0b013e31821fd469 CrossRefPubMed

34.

Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO (2011) Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med 124:144–154.e8. doi:10.1016/j.amjmed.2010.09.013 CrossRefPubMed

35.

Kirk HJ, Heys SD (2003) Immunonutrition. Br J Surg 90:1459–1460CrossRefPubMed

36.

Caglayan K, Oner I, Gunerhan Y, Ata P, Koksal N, Ozkara S (2012) The impact of preoperative immunonutrition and other nutrition models on tumor infiltrative lymphocytes in colorectal cancer patients. Am J Surg 204:416–421. doi:10.1016/j.amjsurg.2011.12.018 CrossRefPubMed

37.

Morris MS, Graham LA, Chu DI, Cannon JA, Hawn MT (2015) Oral antibiotic bowel preparation significantly reduces surgical site infection rates and readmission rates in elective colorectal surgery. Ann Surg 262:331–337. doi:10.1097/SLA.0000000000001041 CrossRef

38.

Zhang JW, Du P, Gao J, Yang BR, Fang WJ, Ying CM (2012) Preoperative probiotics decrease postoperative infectious complications of colorectal cancer. Am J Med Sci 343:199–205. doi:10.1097/MAJ.0b013e31823aace6 CrossRefPubMed

39.

Liu ZH, Huang MJ, Zhang XW, Wang L, Huang NQ, Peng H, Lan P, Peng JS, Yang Z, Xia Y, Liu WJ, Yang J, Qin HL, Wang JP (2013) The effects of perioperative probiotic treatment on serum zonulin concentration and subsequent postoperative infectious complications after colorectal cancer surgery: a double-center and double-blind randomized clinical trial. Am J Clin Nutr 97:117–126. doi:10.3945/ajcn.112.040949 CrossRefPubMed

40.

Spanjersberg WR, Reurings J, Keus F, vanLaarhoven CJ (2011) Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev 16:CD007635. doi:10.1002/14651858.CD007635.pub2

41.

Ren L, Zhu D, Wei Y, Pan X, Liang L, Xu J, Zhong Y, Xue Z, Jin L, Zhan S, Niu W, Qin X, Wu Z, Wu Z (2012) Enhanced recovery after surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial. World J Surg 36:407–414. doi:10.1007/s00268-011-1348-4 CrossRefPubMed

42.

Vlug MS, Wind J, Hollmann MW, Ubbink DT, Cense HA, Engel AF, Gerhards MF, van Wagensveld BA, van der Zaag ES, van Geloven AA, Sprangers MA, Cuesta MA, Bemelman WA, LAFA study group (2011) Laparoscopy in combination with fast track multimodal management is the best perioperative strategy in patients undergoing colonic surgery: a randomized clinical trial (LAFA-study). Ann Surg 254:868–875. doi:10.1097/SLA.0b013e31821fd1ce CrossRefPubMed

43.

ERAS Compliance Group (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159. doi:10.1097/SLA.0000000000001029 CrossRef

44.

Lin X, Li J, Chen W, Wei F, Ying M, Wei W, Xie X (2015) Diabetes and risk of anastomotic leakage after gastrointestinal surgery. J Surg Res 196:294–301. doi:10.1016/j.jss.2015.03.017 CrossRefPubMed

45.

Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, Zaharie FV, Osian G, Puia CI, Muntean V (2008) Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointestin Liver Dis 17:299–303PubMed

Title: Malignancy is a risk factor for postoperative infectious complications after elective colorectal resection
Authors: Thibault Crombe
Jérôme Bot
Mathieu Messager
Vianney Roger
Christophe Mariette
Guillaume Piessen
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 4/2016
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-016-2521-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Malignancy is a risk factor for postoperative infectious complications after elective colorectal resection

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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