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

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

doi:10.1007/s12672-021-00396-8

Atsushi Ikeda, Satoshi Nagayama + Show 7 more

Open Access

https://doi.org/10.1007/s12672-021-00396-8

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Abstract

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

Highlights

Wound infection is one of the most frequent types of nosocomial infections, and it is a major cause of postoperative complications
This study aimed to evaluate the differences in incidence rates and risk factors of wound infection between laparoscopic colon and rectal surgeries for primary colorectal cancer, using data from a prospective surveillance program of surgical site infection (SSI) at a single comprehensive cancer center
3170 patients underwent elective laparoscopic colorectal cancer surgery during the 106-month period, and all patients were admitted to our surveillance program, with all cases being eligible for the study

Summary

Introduction

Wound infection is one of the most frequent types of nosocomial infections, and it is a major cause of postoperative complications. In colorectal surgery, wound infection develops at a higher rate than in other types of operations [1], due to the high bacterial load present within the colorectal lumen. Wound infection is rarely life-threatening, it occasionally leads to mortality. Medical cost increases, hospital stay is prolonged, and the patient’s quality of life decreases [2, 3]. Prevention against wound infection has been regarded as one of the most important issues for colorectal surgeons [4, 5]. Rectal surgery has different incidence rates and risk factors of wound infection, compared with colon surgery [6, 7]

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