Risk factors for surgical site infection and association of surgical site infection with survival of lower rectal cancer patients without clinical lateral pelvic lymph node metastasis (clinical Stage II/III): Analysis of data from JCOG0212

Kenji Katsumata,Mitsuyoshi Ota,Tetsuo Ishizaki,Masanobu Enomoto,Yukihide Kanemitsu,Hiroyuki Bando,Ryunosuke Machida,Takashi Yamaguchi,Akio Shiomi,Takaya Kobatake,Masaaki Ito,M Sekimoto ,Shin Fujita,Masayuki Ohue,Takayuki Aoki ,Yoshihiro Akazai,Manabu Shiozawa,Koji Kono ,Yoshihiro Moriya

doi:10.1007/s10585-021-10117-8

Abstract

This study aimed to examine the risk factors for surgical site infection (SSI) and the association of that with recurrence in JCOG0212. The results for secondary endpoints showed that compared with the mesorectal excision (ME) alone group, ME with lateral lymph node dissection (LLND) group showed significantly longer operative time and significantly higher blood loss. These results suggested that LLND was a risk factor for SSI. All 701 patients registered in JCOG0212 were analyzed in this study. Wound infection was defined as incisional/deep SSI, and pelvic abscess and anastomotic leakage were defined as organ/space SSI. The risk factors for the incidence of SSI and the effect of SSI on relapse-free survival (RFS) were investigated. Multivariable odds ratio of Grade 2 or higher all SSI was 0.58 [95% Confidence interval: 0.36–0.93] for female (vs. male) and that of Grade 2 or higher incisional/deep SSI was 2.24 [1.03–4.86] for blood infusion. For RFS, patients with Grade 3 or higher all SSI showed poor prognosis (multivariable hazard ratio: 1.66 [1.03–2.68]). LLND is not significant factor for the incidence of all SSI. Male sex might be a risk factor of Grade 2 or higher SSI, and blood transfusion is a possible risk factor of Grade 2 or higher incisional/deep SSI. Grade 3 or higher all SSI might be a significant worse prognostic factor for lower rectal cancer.

Highlights

Surgical site infection (SSI), an infection associated with surgery, is a major complication
The incidence of wound infection and anastomotic leakage is more frequent in rectal cancer than in other organ cancers [6]
Prolongation of the operative time and increase of the bleeding are major factors of the incidence of SSI. Even when these negative factors were considered, the results showed that lateral lymph node dissection (LLND) was the standard procedure performed

Summary

Introduction

Surgical site infection (SSI), an infection associated with surgery, is a major complication. Risk factors for the incidence of Grade 2 or higher SSI were analyzed according to definitions of SSI (all SSI, incisional/deep SSI, and organ/space SSI).

Objectives

Results

Conclusion