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Abstract
This study aims to systematically assess the efficacy of parenteral and oral antibiotic prophylaxis compared to parenteral-only prophylaxis for the prevention of surgical site infection (SSI) in patients undergoing laparoscopic surgery for colorectal cancer resection. Published and unpublished randomized clinical trials comparing the use of oral and parenteral prophylactic antibiotics vs. parenteral-only antibiotics in patients undergoing laparoscopic colorectal surgery were collected searching electronic databases (MEDLINE, CENTRAL, EMBASE, SCIENCE CITATION INDEX EXPANDED) without limits of date, language, or any other search filter. The outcomes included SSIs and other infectious and noninfectious postoperative complications. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). A total of six studies involving 2252 patients were finally included, with 1126 cases in the oral and parenteral group and 1126 cases in the parenteral-only group. Meta-analysis results showed a statistically significant reduction of SSIs (OR 0.54, 95% CI 0.40 to 0.72; p < 0.0001) and anastomotic leakage (OR 0.55, 95% CI 0.33 to 0.91; p = 0.02) in the group of patients receiving oral antibiotics in addition to intravenous (IV) antibiotics compared to IV alone. Our meta-analysis shows that a combination of oral antibiotics and intravenous antibiotics significantly lowers the incidence of SSI compared with intravenous antibiotics alone.
Highlights
Surgical site infection (SSI) is defined as an infection of superficial or deep tissue or organs at the surgical site or related to the site of the surgical procedure [1]
Our meta-analysis showed that a combination of oral antibiotics and intravenous antibiotics could significantly lower the incidence of Surgical Site Infections (SSIs) compared with intravenous antibiotics alone in patients undergoing laparoscopic colorectal resection
The results of this study found that patients receiving a combination of oral and IV antibiotics had decreased SSIs compared to patients receiving only IV antibiotics
Summary
Surgical site infection (SSI) is defined as an infection of superficial or deep tissue or organs at the surgical site or related to the site of the surgical procedure [1]. Antibiotic prophylaxis has been shown to have a pivotal role for preventing SSIs in patients undergoing elective colorectal surgery [5,6,7]. Authors reported evidence regarding the effect of oral and parenteral prophylaxis in colorectal surgery [8,9,10], but none of them referred to laparoscopic surgery. Laparoscopic surgery can achieve similar oncological outcomes as compared with open surgery [11,12] and showed potential advantages, including less bleeding, faster postoperative recovery, less pain, and less wound-related complications [13,14,15,16]. Further research is needed on the effectiveness of pre-operative oral antibiotic regimen in patients undergoing elective laparoscopic colon surgery
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