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Deep Pelvic Surgical Site Infection After Radiotherapy and Surgery for Locally Advanced Rectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

High morbidity, increased mortality, and impaired long-term oncologic outcome have been reported after deep surgical site infection (SSI) in rectal cancer surgery. The rate, risk factors and consequences of deep SSI after (chemo)radiotherapy [(C)RT], and surgery for locally advanced rectal cancer (LARC) in a tertiary university hospital single centre cohort of 540 patients are presented.

Methods

Patients with LARC, operated between January 1, 2007 and December 31, 2015, were identified in the institutional prospective database. All patients had tumours threatening the mesorectal fascia or invading adjacent organs, with a high rate of T4 tumours (60 %), and all received (C)RT. Risk factors for deep SSI were calculated by multivariable logistic regression analysis. Morbidity data were assessed. Overall survival (OS) and disease-free survival (DFS) between patients with or without deep SSI were estimated.

Results

Of 540 patients, 104 (19 %) experienced a deep SSI, with the highest rate in the abdominoperineal resection (APR) group with 25 %. APR, good response to (C)RT (low tumour regression grade), age, and operative blood loss were identified as significant (P < 0.05) risk factors for deep SSI in multivariable analysis. No difference was found in OS (P = 0.995) or DFS (P = 0.568). Hospital stay increased with 5 days (P < 0.001), and complete wound healing at the 3-month follow-up decreased from 86 to 45 % (P < 0.001) after deep SSI.

Conclusions

Deep SSI is a frequent and major complication after rectal surgery for LARC, with high morbidity, increased hospital stay and protracted wound healing. Interestingly, deep SSI did not influence long-term oncologic outcome.

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Acknowledgment

The authors thank the staff at the Department of Surgery at the Norwegian Radium Hospital Oslo University Hospital for their daily efforts and dedication for the patients. A special thanks goes to Veronica M. Alexandersen for her invaluable help with sorting and plotting of patient data.

Disclosure

The authors declare no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway

      E. B. Thorgersen MD, PhD, M. A. Goscinski MD, PhD, M. Spasojevic MD, PhD, A. M. Solbakken MD, A. B. Mariathasan MD, S. G. Larsen MD, PhD & K. Flatmark MD, PhD

    2. Institute of Immunology, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway

      E. B. Thorgersen MD, PhD

    3. Department of Oncology, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway

      K. Boye MD, PhD

    4. Department of Tumour Biology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

      K. Boye MD, PhD & K. Flatmark MD, PhD

    5. Institute of Clinical Medicine, University of Oslo, Oslo, Norway

      K. Flatmark MD, PhD

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    1. E. B. Thorgersen MD, PhD
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    Correspondence to E. B. Thorgersen MD, PhD.

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    S. G. Larsen and K. Flatmark have contributed equally to the study.

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    Thorgersen, E.B., Goscinski, M.A., Spasojevic, M. et al. Deep Pelvic Surgical Site Infection After Radiotherapy and Surgery for Locally Advanced Rectal Cancer. Ann Surg Oncol 24, 721–728 (2017). https://doi.org/10.1245/s10434-016-5621-5

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    • DOI: https://doi.org/10.1245/s10434-016-5621-5

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