Selective Decontamination of the Digestive Tract to Prevent Postoperative Pneumonia and Anastomotic Leakage after Esophagectomy: A Retrospective Cohort Study

Robin Janssen,Eva Kolwijck,Frans Van Workum,Jaap Ten Oever,Nikolaj Baranov,Camiel Rosman,Alma Tostmann,Jeroen Schouten,Harmen Blok

doi:10.3390/antibiotics10010043

Abstract

Infectious complications occur frequently after esophagectomy. Selective decontamination of the digestive tract (SDD) has been shown to reduce postoperative infections and anastomotic leakage in gastrointestinal surgery, but robust evidence for esophageal surgery is lacking. The aim was to evaluate the association between SDD and pneumonia, surgical-site infections (SSIs), anastomotic leakage, and 1-year mortality after esophagectomy. A retrospective cohort study was conducted in patients undergoing Ivor Lewis esophagectomy in four Dutch hospitals between 2012 and 2018. Two hospitals used SDD perioperatively and two did not. SDD consisted of an oral paste and suspension (containing amphotericin B, colistin, and tobramycin). The primary outcomes were 30-day postoperative pneumonia and SSIs. Secondary outcomes were anastomotic leakage and 1-year mortality. Logistic regression analyses were performed to determine the association between SDD and the relevant outcomes (odds ratio (OR)). A total of 496 patients were included, of whom 179 received SDD perioperatively and the other 317 patients did not receive SDD. Patients who received SDD were less likely to develop postoperative pneumonia (20.1% vs. 36.9%, p < 0.001) and anastomotic leakage (10.6% vs. 19.9%, p = 0.008). Multivariate analysis showed that SDD is an independent protective factor for postoperative pneumonia (OR 0.40, 95% CI 0.23–0.67, p < 0.001) and anastomotic leakage (OR 0.46, 95% CI 0.26–0.84, p = 0.011). Use of perioperative SDD seems to be associated with a lower risk of pneumonia and anastomotic leakage after esophagectomy.

Highlights

Esophagectomy is a complex surgical procedure, associated with significant morbidity and mortality rates [1,2]
Pathogens originating from the gastrointestinal (GI) tract reaching the site of the anastomosis can induce local inflammation with abscess formation, facilitating anastomotic dehiscence and, eventually, anastomotic leakage [8,9,10]
This study found that, in patients undergoing Ivor Lewis totally minimally invasive esophagectomy (TMIE), perioperative Selective decontamination of the digestive tract (SDD)

Summary

Introduction

Esophagectomy is a complex surgical procedure, associated with significant morbidity and mortality rates [1,2]. Most postoperative complications involve infectious complications (10–30%), including pulmonary infections, surgical-site infections (SSIs), and anastomotic leakage [1,2,3,4]. Pathogens originating from the gastrointestinal (GI) tract reaching the site of the anastomosis can induce local inflammation with abscess formation, facilitating anastomotic dehiscence and, eventually, anastomotic leakage [8,9,10]. Eliminating these pathogens prior to surgery and during recovery may decrease the risk of infections and anastomotic leakage

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