Top

Published in:

Open Access 01-12-2021 | Wound Infection | Research

Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases

Authors: Atsushi Ikeda, Yosuke Fukunaga, Takashi Akiyoshi, Satoshi Nagayama, Toshiya Nagasaki, Tomohiro Yamaguchi, Toshiki Mukai, Yukiharu Hiyoshi, Tsuyoshi Konishi

Published in: Discover Oncology | Issue 1/2021

Abstract

Objectives

This prospective observational study aimed to clarify the incidence and independent risk factors of wound infection after laparoscopic surgery for primary colonic and rectal cancer.

Methods

A prospective surveillance of surgical site infection (SSI) was conducted in consecutive patients with primary colorectal cancer, who underwent elective laparoscopic surgery in a single comprehensive cancer center between 2005 and 2014. The outcomes of interest were the incidence and risk factors of wound infection.

Results

In total, 3170 patients were enrolled in the study. The overall incidence of wound infection was 3.0%. The incidence of wound infection was significantly higher in rectal surgery than in colonic surgery (4.7 vs. 2.1%, p < 0.001). In rectal surgery, independent risk factors for developing wound infection included abdominoperineal resection (p < 0.001, odds ratio [OR] = 11.4, 95% confidence interval [CI]: 5.04–24.8), body mass index (BMI) ≥ 25 kg/m² (p = 0.041, OR = 1.97, 95% CI, 1.03–3.76), and chemoradiotherapy (p = 0.032, OR = 2.18, 95% CI, 1.07–4.45). In laparoscopic colonic surgery, no significant risk factors were identified.

Conclusions

Laparoscopic rectal surgery has a higher risk of wound infection than colonic surgery. Laparoscopic rectal surgery involving abdominoperineal resection, patients with higher BMI, and chemoradiotherapy requires careful observation in wound care and countermeasures against wound infection.

National Nosocomial Infections Surveillance S. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control. 2004;32(8):470–85. https://doi.org/10.1016/S0196655304005425.

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725–30. https://doi.org/10.1086/501572.CrossRefPubMed

Mahmoud NN, Turpin RS, Yang G, Saunders WB. Impact of surgical site infections on length of stay and costs in selected colorectal procedures. Surg Infect (Larchmt). 2009;10(6):539–44. https://doi.org/10.1089/sur.2009.006.CrossRef

Smith RL, Bohl JK, McElearney ST, Friel CM, Barclay MM, Sawyer RG, et al. Wound infection after elective colorectal resection. Annals Surg. 2004;239(5):599–607. https://doi.org/10.1097/01.sla.0000124292.21605.99.CrossRef

Weiss CA, Statz CL, Dahms RA, Remucal MJ, Dunn DL, Beilman GJ. Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Arch Surg. 1999;134(10):1041–8.CrossRef

Konishi T, Watanabe T, Kishimoto J, Nagawa H. Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg. 2006;244(5):758–63. https://doi.org/10.1097/01.sla.0000219017.78611.49.CrossRefPubMedPubMedCentral

Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg. 2006;202(3):439–44. https://doi.org/10.1016/j.jamcollsurg.2005.10.019.CrossRefPubMed

Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc. 1991;1(3):144–50.PubMed

Kulkarni N, Arulampalam T. Laparoscopic surgery reduces the incidence of surgical site infections compared to the open approach for colorectal procedures: a meta-analysis. Tech Coloproctol. 2020;24(10):1017–24. https://doi.org/10.1007/s10151-020-02293-8.CrossRefPubMed

10.

Yamamoto S, Ito M, Okuda J, Fujii S, Yamaguchi S, Yoshimura K, et al. Laparoscopic surgery for stage 0/I rectal carcinoma: short-term outcomes of a single-arm phase II trial. Ann Surg. 2013;258(2):283–8. https://doi.org/10.1097/SLA.0b013e318283669c.CrossRefPubMed

11.

Poon JT, Law WL, Wong IW, Ching PT, Wong LM, Fan JK, et al. Impact of laparoscopic colorectal resection on surgical site infection. Ann Surg. 2009;249(1):77–81. https://doi.org/10.1097/SLA.0b013e31819279e3.CrossRefPubMed

12.

Romy S, Eisenring MC, Bettschart V, Petignat C, Francioli P, Troillet N. Laparoscope use and surgical site infections in digestive surgery. Ann Surg. 2008;247(4):627–32. https://doi.org/10.1097/SLA.0b013e3181638609.CrossRefPubMed

13.

Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018;24(21):2247–60. https://doi.org/10.3748/wjg.v24.i21.2247.CrossRefPubMedPubMedCentral

14.

Mukai T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Outcomes of laparoscopic surgery for colorectal cancer in oldest-old patients. Surg Laparosc Endosc Percutan Tech. 2014;24(4):366–9. https://doi.org/10.1097/SLE.0b013e31829012ca.CrossRefPubMed

15.

Akiyoshi T, Kuroyanagi H, Oya M, Ueno M, Fujimoto Y, Konishi T, et al. Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc. 2010;24(11):2749–54. https://doi.org/10.1007/s00464-010-1039-5.CrossRefPubMed

16.

Akiyoshi T, Kuroyanagi H, Fujimoto Y, Konishi T, Ueno M, Oya M, et al. Short-term outcomes of laparoscopic colectomy for transverse colon cancer. J Gastrointest Surg. 2010;14:818–23.CrossRef

17.

Ikeda A, Fukunaga Y, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, et al. Laparoscopic right colectomy in patients treated with previous gastrectomy. Surg Today. 2016;46(2):209–13. https://doi.org/10.1007/s00595-015-1157-8.CrossRefPubMed

18.

Akiyoshi T. Technical feasibility of laparoscopic extended surgery beyond total mesorectal excision for primary or recurrent rectal cancer. World J Gastroenterol. 2016;22(2):718–26. https://doi.org/10.3748/wjg.v22.i2.718.CrossRefPubMedPubMedCentral

19.

Nagasaki T, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Feasibility and safety of laparoscopic surgery for metachronous colorectal cancer. Surg Today. 2014. https://doi.org/10.1007/s00595-014-0925-1.CrossRefPubMed

20.

Nagasue Y, Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes. J Gastrointest Surg. 2013;17(7):1299–305. https://doi.org/10.1007/s11605-013-2222-5.CrossRefPubMed

21.

Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T. Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg. 2005;92(6):756–63. https://doi.org/10.1002/bjs.4975.CrossRefPubMed

22.

Emori TG, Culver DH, Horan TC, Jarvis WR, White JW, Olson DR, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control. 1991;19(1):19–35. https://doi.org/10.1016/0196-6553(91)90157-8.CrossRefPubMed

23.

Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20(4):250–78. https://doi.org/10.1086/501620.CrossRefPubMed

24.

Ikeda A, Konishi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, et al. Randomized clinical trial of oral and intravenous versus intravenous antibiotic prophylaxis for laparoscopic colorectal resection. Br J Surg. 2016;103(12):1608–15. https://doi.org/10.1002/bjs.10281.CrossRefPubMed

25.

Kurmann A, Vorburger SA, Candinas D, Beldi G. Operation time and body mass index are significant risk factors for surgical site infection in laparoscopic sigmoid resection: a multicenter study. Surg Endosc. 2011;25(11):3531–4. https://doi.org/10.1007/s00464-011-1753-7.CrossRefPubMed

26.

Kitano S, Kitajima M, Konishi F, Kondo H, Satomi S, Shimizu N. A multicenter study on laparoscopic surgery for colorectal cancer in Japan. Surg Endosc. 2006;20(9):1348–52. https://doi.org/10.1007/s00464-004-8247-9.CrossRefPubMed

27.

Yamamoto S, Inomata M, Katayama H, Mizusawa J, Etoh T, Konishi F, et al. Short-term surgical outcomes from a randomized controlled trial to evaluate laparoscopic and open D3 dissection for stage II/III colon cancer. Ann Surg. 2014;260(1):23–30. https://doi.org/10.1097/SLA.0000000000000499.CrossRefPubMed

28.

Yamamoto S, Fujita S, Akasu T, Ishiguro S, Kobayashi Y, Moriya Y. Wound infection after elective laparoscopic surgery for colorectal carcinoma. Surg Endosc. 2007;21(12):2248–52. https://doi.org/10.1007/s00464-007-9358-x.CrossRefPubMed

29.

Makino T, Trencheva K, Shukla PJ, Rubino F, Zhuo C, Pavoor RS, et al. The influence of obesity on short- and long-term outcomes after laparoscopic surgery for colon cancer: a case-matched study of 152 patients. Surgery. 2014. https://doi.org/10.1016/j.surg.2014.03.023.CrossRefPubMed

30.

Gurunathan U, Ramsay S, Mitric G, Way M, Wockner L, Myles P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg. 2017;21(10):1700–12. https://doi.org/10.1007/s11605-017-3494-y.CrossRefPubMed

31.

Gendall KA, Raniga S, Kennedy R, Frizelle FA. The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum. 2007;50(12):2223–37. https://doi.org/10.1007/s10350-007-9051-0.CrossRefPubMed

32.

Akiyoshi T, Ueno M, Fukunaga Y, Nagayama S, Fujimoto Y, Konishi T, et al. Effect of body mass index on short-term outcomes of patients undergoing laparoscopic resection for colorectal cancer: a single institution experience in Japan. Surg Laparosc Endosc Percutan Tech. 2011;21(6):409–14. https://doi.org/10.1097/SLE.0b013e31822e5fdc.CrossRefPubMed

33.

Gurunathan U, Ramsay S, Mitrić G, Way M, Wockner L, Myles P. Association between obesity and wound infection following colorectal surgery: systematic review and meta-analysis. J Gastrointest Surg. 2017;21(10):1700–12. https://doi.org/10.1007/s11605-017-3494-y.CrossRefPubMed

34.

Pikarsky AJ, Saida Y, Yamaguchi T, Martinez S, Chen W, Weiss EG, et al. Is obesity a high-risk factor for laparoscopic colorectal surgery? Surg Endosc. 2002;16(5):855–8. https://doi.org/10.1007/s004640080069.CrossRefPubMed

35.

de Bruin AF, Gosselink MP, Wijffels NA, Coene PP, van der Harst E. Local gentamicin reduces perineal wound infection after radiotherapy and abdominoperineal resection. Tech Coloproctol. 2008;12(4):303–7. https://doi.org/10.1007/s10151-008-0440-8.CrossRefPubMed

36.

Perry WB, Connaughton JC. Abdominoperineal resection: how is it done and what are the results? Clin Colon Rectal Surg. 2007;20(3):213–20. https://doi.org/10.1055/s-2007-984865.CrossRefPubMedPubMedCentral

37.

Musters GD, Buskens CJ, Bemelman WA, Tanis PJ. Perineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis. Dis Colon Rectum. 2014;57(9):1129–39. https://doi.org/10.1097/DCR.0000000000000182.CrossRefPubMed

Title: Wound infection in colorectal cancer resections through a laparoscopic approach: a single-center prospective observational study of over 3000 cases
Authors: Atsushi Ikeda
Yosuke Fukunaga
Takashi Akiyoshi
Satoshi Nagayama
Toshiya Nagasaki
Tomohiro Yamaguchi
Toshiki Mukai
Yukiharu Hiyoshi
Tsuyoshi Konishi
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Wound Infection
Colorectal Cancer
Colorectal Cancer
Rectal Cancer
Rectal Cancer
Published in: Discover Oncology / Issue 1/2021
Print ISSN: 1868-8497
Electronic ISSN: 2730-6011
DOI: https://doi.org/10.1007/s12672-021-00396-8

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

IGF-1R nuclear import and recruitment to chromatin involves both alpha and beta subunits

Focal adhesion kinase inhibitors, a heavy punch to cancer

Temporal trends in the incidence rates of keratinocyte carcinomas from 1978 to 2018 in Tasmania, Australia: a population-based study

Anal squamous cell carcinoma in a high HIV prevalence population

HOXC10 promotes growth and migration of melanoma by regulating Slug to activate the YAP/TAZ signaling pathway

Differences between lung adenocarcinoma and squamous cell carcinoma in histological distribution of residual tumor after induction chemoradiotherapy

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials