A Prospective Cohort Study To Evaluate the Feasibility of Intraoperative Antimicrobial Prophylaxis in Open Gastrectomy for Gastric Cancer.

Abstract

The optimal duration of antimicrobial prophylaxis (AMP) in patients undergoing gastric cancer surgery remains debatable. The aim of this prospective cohort study was to evaluate the feasibility of intraoperative AMP in comparison with conventional AMP in patients undergoing elective open gastrectomy. The duration of AMP was shortened in two six-monthly stages in patients undergoing open gastrectomy for gastric cancer, and the incidences of surgical site infections (SSIs) and remote infections (RIs) were surveyed. In the first stage (September 2004 to February 2005), the patients received four intravenous injections of cefazolin 1 g at 12-h intervals starting from 30 min before surgery (conventional AMP). In the second stage (March 2005 to August 2005), the patients received the same agent at three-h intervals starting 30 min before surgery and continuing until the end of the operation (intraoperative AMP). A total of 423 patients were enrolled, including 202 patients operated on in the first stage of cancer and 221 patients operated on in the second stage. The patient characteristics in the two stages were well balanced. There was no significant difference in the incidence of SSIs (10.4% vs. 8.1%; odds ratio [OR], 0.764; 95% confidence interval [CI] 0.395-1.480; p = 0.528) or RIs (7.9% vs. 5.9%; OR 0.727; 95% CI 0.340-1.551; p = 0.525) between the two stages. There were no serious adverse events related to the AMP. The treatment effects on the SSIs were similar in all subgroups of patients analyzed. There was no appreciable difference in the trend in the causative pathogens of the SSIs and RIs between the two stages. Intraoperative and conventional AMP were associated with similar incidences of SSIs and RIs. Intraoperative AMP appears to be feasible and sufficient in patients undergoing open gastrectomy for gastric cancer.