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Clinical and surgical factors associated with organ/space surgical site infection after laparoscopic gastrectomy for gastric cancer

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Abstract

Background

Surgical site infection (SSI), particularly organ/space SSI, remains a clinically important issue even after laparoscopic gastrectomy (LG) for gastric cancer (GC). This study aimed to identify specific clinical and surgical factors associated with organ/space SSI after LG.

Methods

This was a retrospective study of 407 patients who underwent LG for clinical stage I GC. SSI was defined according to the National Nosocomial Infection Surveillance System. The incidence and treatment outcomes of either incisional or organ/space SSI after LG were examined, and the risk factors for each type of SSI were identified using univariate and multivariate analyses.

Results

Organ/space SSI was observed in 21 patients (5.2 %), while incisional SSI was detected in 18 patients (4.4 %). Although no mortality was observed, the occurrence of either incisional or organ/space SSI significantly prolonged postoperative hospital stays (p = 0.000 and 0.000, respectively); however, organ/space SSI required more re-operations and re-admissions, and eventually longer total hospital stays than incisional SSI (p = 0.036). Intra-abdominal abscess around the pancreas was the main cause of organ/space SSI, while no anastomotic leakage was observed. Multivariate analyses identified male gender (odds ratio (OR) 3.385; 95 % confidence interval (CI) 1.073–15.07, p = 0.037), chronic liver disease (OR 8.897; 95 % CI 2.502–28.99, p = 0.001), and total gastrectomy (TG) (OR 3.817; 95 % CI 1.380–10.24, p = 0.011) as independent risk factors for organ/space SSI, while TG (OR 3.130; 95 % CI 1.102–8.768, p = 0.033) and operation time ≥320 min (OR 3.732; 95 % CI 1.109–16.98, p = 0.033) were independently associated with incisional SSI.

Conclusions

Male gender, chronic liver disease, and TG are independent risk factors for organ/space SSI after LG for GC; thus, meticulous surgical procedures need to be performed among patients with these specific risk factors.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer 127(12):2893–2917

    Article  CAS  PubMed  Google Scholar 

  2. Leung WK, Wu MS, Kakugawa Y, Kim JJ, Yeoh KG, Goh KL et al (2008) Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9(3):279–287

    Article  PubMed  Google Scholar 

  3. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(1):68–72

    Article  PubMed  PubMed Central  Google Scholar 

  4. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M et al (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13(4):238–244

    Article  PubMed  Google Scholar 

  5. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS trial). Ann Surg 251(3):417–420

    Article  PubMed  Google Scholar 

  6. Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW et al (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263(1):28–35

    Article  PubMed  Google Scholar 

  7. Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T et al (2012) Risk factors for surgical site infections after elective gastrectomy. J Gastrointest Surg 16(6):1107–1115

    Article  PubMed  Google Scholar 

  8. Tu RH, Huang CM, Lin JX, Chen QY, Zheng CH, Li P et al (2015) A scoring system to predict the risk of organ/space surgical site infections after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Surg Endosc 30(7):3026–3034

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4):250–78; quiz 79–80

  10. Inokuchi M, Sugita H, Otsuki S, Sato Y, Nakagawa M, Kojima K (2015) Laparoscopic distal gastrectomy reduced surgical site infection as compared with open distal gastrectomy for gastric cancer in a meta-analysis of both randomized controlled and case-controlled studies. Int J Surg 15:61–67

    Article  PubMed  Google Scholar 

  11. Vinuela EF, Gonen M, Brennan MF, Coit DG, Strong VE (2012) Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg 255(3):446–456

    Article  PubMed  Google Scholar 

  12. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112

  13. Ichikawa D, Komatsu S, Kubota T, Okamoto K, Konishi H, Shiozaki A et al (2015) Evaluation of the safety and feasibility of laparoscopic total gastrectomy in clinical stage I gastric cancer patients. World J Surg 39(7):1782–1788

    Article  PubMed  Google Scholar 

  14. Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E (2012) Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen. Langenbecks Arch Surg 397(1):57–62

    Article  PubMed  Google Scholar 

  15. Ichikawa D, Kubota T, Kikuchi S, Fujiwara H, Nakanishi M, Ikoma H et al (2009) Intracorporeal Billroth-I anastomosis using a circular stapler by the abdominal wall lifting method in laparoscopy-assisted distal gastrectomy. Surg Laparosc Endosc Percutan Tech 19(5):e163–e166

    Article  PubMed  Google Scholar 

  16. Kosuga T, Ichikawa D, Okamoto K, Komatsu S, Konishi H, Takeshita H et al (2015) Impact of age on early surgical outcomes of laparoscopy-assisted gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer. Anticancer Res 35(4):2191–2198

    PubMed  Google Scholar 

  17. Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A et al (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):929–935

    Article  Google Scholar 

  18. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123

    Article  Google Scholar 

  19. Vesper BJ, Jawdi A, Altman KW, Haines GK 3rd, Tao L, Radosevich JA (2009) The effect of proton pump inhibitors on the human microbiota. Curr Drug Metab 10(1):84–89

    Article  CAS  PubMed  Google Scholar 

  20. Williams C, McColl KE (2006) Review article: proton pump inhibitors and bacterial overgrowth. Aliment Pharmacol Ther 23(1):3–10

    Article  CAS  PubMed  Google Scholar 

  21. Inokuchi M, Kato K, Sugita H, Otsuki S, Kojima K (2014) Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer. BMC Surg 14:97

    Article  PubMed  PubMed Central  Google Scholar 

  22. Seidell JC, Flegal KM (1997) Assessing obesity: classification and epidemiology. Br Med Bull 53(2):238–252

    Article  CAS  PubMed  Google Scholar 

  23. Iwata N, Kodera Y, Eguchi T, Ohashi N, Nakayama G, Koike M et al (2010) Amylase concentration of the drainage fluid as a risk factor for intra-abdominal abscess following gastrectomy for gastric cancer. World J Surg 34(7):1534–1539

    Article  PubMed  Google Scholar 

  24. Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, Sano T et al (2012) Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 19(1):115–121

    Article  PubMed  Google Scholar 

  25. Kanda M, Fujiwara M, Tanaka C, Kobayashi D, Iwata N, Mizuno A et al (2016) Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy. Surg Endosc. doi:10.1007/s00464-016-4753-9

  26. Hirao M, Tsujinaka T, Imamura H, Kurokawa Y, Inoue K, Kimura Y et al (2013) Overweight is a risk factor for surgical site infection following distal gastrectomy for gastric cancer. Gastric Cancer 16(2):239–244

    Article  PubMed  Google Scholar 

  27. Kawamura Y, Satoh S, Suda K, Ishida Y, Kanaya S, Uyama I (2015) Critical factors that influence the early outcome of laparoscopic total gastrectomy. Gastric Cancer 18(3):662–668

    Article  PubMed  Google Scholar 

  28. Kim DJ, Lee JH, Kim W (2015) Comparison of the major postoperative complications between laparoscopic distal and total gastrectomies for gastric cancer using Clavien–Dindo classification. Surg Endosc 29(11):3196–3204

    Article  PubMed  Google Scholar 

  29. Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S et al (2014) Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 21(6):2028–2035

    Article  PubMed  Google Scholar 

  30. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK (2014) Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 21(9):2994–3001

    Article  PubMed  Google Scholar 

  31. Kosuga T, Hiki N, Nunobe S, Ohashi M, Kubota T, Kamiya S et al (2015) Does the single-stapling technique for circular-stapled esophagojejunostomy reduce anastomotic complications after laparoscopic total gastrectomy? Ann Surg Oncol 22(11):3606–3612

    Article  PubMed  Google Scholar 

  32. Wada N, Kurokawa Y, Takiguchi S, Takahashi T, Yamasaki M, Miyata H et al (2014) Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer 17(1):137–140

    Article  PubMed  Google Scholar 

  33. Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K et al (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg 144(4):351–358; discussion 8

  34. Hwang SH, Park do J, Jee YS, Kim HH, Lee HJ, Yang HK et al (2009) Risk factors for operative complications in elderly patients during laparoscopy-assisted gastrectomy. J Am Coll Surg 208(2):186–192

    Article  PubMed  Google Scholar 

  35. Jeong SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH et al (2010) Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol 101(3):200–204

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan

    Toshiyuki Kosuga, Daisuke Ichikawa, Shuhei Komatsu, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara & Eigo Otsuji

  2. Department of Gastroenterological Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan

    Takeshi Kubota

Authors
  1. Toshiyuki Kosuga
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  2. Daisuke Ichikawa
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  3. Shuhei Komatsu
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  4. Takeshi Kubota
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  5. Kazuma Okamoto
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  6. Hirotaka Konishi
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  7. Atsushi Shiozaki
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  8. Hitoshi Fujiwara
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  9. Eigo Otsuji
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Correspondence to Daisuke Ichikawa.

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Disclosure

Toshiyuki Kosuga, Daisuke Ichikawa, Shuhei Komatsu, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, and Eigo Otsuji have no conflicts of interest or financial ties to disclose.

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Kosuga, T., Ichikawa, D., Komatsu, S. et al. Clinical and surgical factors associated with organ/space surgical site infection after laparoscopic gastrectomy for gastric cancer. Surg Endosc 31, 1667–1674 (2017). https://doi.org/10.1007/s00464-016-5156-7

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  • DOI: https://doi.org/10.1007/s00464-016-5156-7

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