International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 277–283 | Cite as

Oncological outcome of surgical site infection after colorectal cancer surgery

  • Jung Wook Huh
  • Woo Yong LeeEmail author
  • Yoon Ah Park
  • Yong Beom Cho
  • Hee Cheol Kim
  • Seong Hyeon Yun
  • Ho-Kyung Chun
Original Article



This study evaluated the oncological outcome of surgical site infection (SSI) after colorectal cancer surgery.


A total of 3675 consecutive patients with colorectal cancer who underwent curative resection from January 2009 to December 2011 were analyzed. The prognostic significance of SSI was evaluated. Risk factors for SSI were also identified using multivariate regression analysis.


Overall SSI rate was 9.6%, in which 5.5% was superficial or deep SSI and 4.1% was organ/space SSI. Incidence of SSI varied significantly with tumor location (P < 0.001): 7.1% in colon cancer and 14.0% in rectal cancer. With a median follow-up period of 49.8 months, the 5-year disease-free survival rates of patients without and with SSI were 87% and 83%, respectively (P = 0.018). SSI predicted disease-free survival in univariate analysis. However, SSI was not an independent predictor of survival in multivariate analysis. Body mass index, ASA score, preoperative WBC count, rectal tumor, open surgery, operation time, and transfusion during surgery were independent predictors of SSI.


SSI predicted disease-free survival in colorectal cancer patients following curative surgery. Patient’ demographics, tumor characteristics, and perioperative conditions were independently associated with an increased likelihood of SSI.


Colorectal cancer Surgical site infection Survival 


Compliance with ethical standards

This project was reviewed and approved by the appropriate institutional review board.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Hedrick TL, Sawyer RG, Friel CM, Stukenborg GJ (2013) A method for estimating the risk of surgical site infection in patients with abdominal colorectal procedures. Dis Colon Rectum 56:627–637CrossRefGoogle Scholar
  2. 2.
    Krieger BR, Davis DM, Sanchez JE, Mateka JJ, Nfonsam VN, Frattini JC, Marcet JE (2011) The use of silver nylon in preventing surgical site infections following colon and rectal surgery. Dis Colon Rectum 54:1014–1019CrossRefGoogle Scholar
  3. 3.
    Anthony T, Murray BW, Sum-Ping JT, Lenkovsky F, Vornik VD, Parker BJ, McFarlin JE, Hartless K, Huerta S (2011) Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. Arch Surg 146:263–269CrossRefGoogle Scholar
  4. 4.
    Ju MH, Ko CY, Hall BL, Bosk CL, Bilimoria KY, Wick EC (2015) A comparison of 2 surgical site infection monitoring systems. JAMA Surg 150:51–57CrossRefGoogle Scholar
  5. 5.
    Murray AC, Pasam R, Estrada D, Kiran RP (2016) Risk of surgical site infection varies based on location of disease and segment of colorectal resection for Cancer. Dis Colon Rectum 59:493–500CrossRefGoogle Scholar
  6. 6.
    Sutton E, Miyagaki H, Bellini G, Shantha Kumara HM, Yan X, Howe B, Feigel A, Whelan RL (2017) Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database. J Surg Res 207:205–214CrossRefGoogle Scholar
  7. 7.
    Amri R, Dinaux AM, Kunitake H, Bordeianou LG, Berger DL (2017) Risk stratification for surgical site infections in Colon Cancer. JAMA Surg 152:686–690CrossRefGoogle Scholar
  8. 8.
    Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ (1999) The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 20:725–730CrossRefGoogle Scholar
  9. 9.
    Olsen MA, Chu-Ongsakul S, Brandt KE, Dietz JR, Mayfield J, Fraser VJ (2008) Hospital-associated costs due to surgical site infection after breast surgery. Arch Surg 143:53–60 discussion 61CrossRefGoogle Scholar
  10. 10.
    Murthy BL, Thomson CS, Dodwell D, Shenoy H, Mikeljevic JS, Forman D, Horgan K (2007) Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 97:1211–1217CrossRefGoogle Scholar
  11. 11.
    Grandis JR, Snyderman CH, Johnson JT, Yu VL, D'Amico F (1992) Postoperative wound infection. A poor prognostic sign for patients with head and neck cancer. Cancer 70:2166–2170CrossRefGoogle Scholar
  12. 12.
    Tsujimoto H, Ichikura T, Ono S, Sugasawa H, Hiraki S, Sakamoto N, Yaguchi Y, Yoshida K, Matsumoto Y, Hase K (2009) Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16:311–318CrossRefGoogle Scholar
  13. 13.
    Nespoli A, Gianotti L, Bovo G, Brivio F, Nespoli L, Totis M (2006) Impact of postoperative infections on survival in colon cancer patients. Surg Infect 7(Suppl 2):S41–S43CrossRefGoogle Scholar
  14. 14.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control 27:97–132 quiz 133–134; discussion 196CrossRefGoogle Scholar
  15. 15.
    Mrak K, Eberl T, Laske A, Jagoditsch M, Fritz J, Tschmelitsch J (2013) Impact of postoperative complications on long-term survival after resection for rectal cancer. Dis Colon Rectum 56:20–28CrossRefGoogle Scholar
  16. 16.
    Matthiessen P, Hallbook O, Andersson M, Rutegard J, Sjodahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Color Dis 6:462–469CrossRefGoogle Scholar
  17. 17.
    Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259:930–938CrossRefGoogle Scholar
  18. 18.
    Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253:890–899CrossRefGoogle Scholar
  19. 19.
    Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY (2016) Risk factors of anastomotic leakage and long-term survival after colorectal surgery. Medicine (Baltimore) 95:e2890CrossRefGoogle Scholar
  20. 20.
    Lawson EH, Hall BL, Ko CY (2013) Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives. JAMA Surg 148:849–858CrossRefGoogle Scholar
  21. 21.
    Pendlimari R, Cima RR, Wolff BG, Pemberton JH, Huebner M (2012) Diagnoses influence surgical site infections (SSI) in colorectal surgery: a must consideration for SSI reporting programs? J Am Coll Surg 214:574–580 discussion 580-571CrossRefGoogle Scholar
  22. 22.
    Tang R, Chen HH, Wang YL, Changchien CR, Chen JS, Hsu KC, Chiang JM, Wang JY (2001) Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg 234:181–189CrossRefGoogle Scholar
  23. 23.
    Young H, Knepper B, Moore EE, Johnson JL, Mehler P, Price CS (2012) Surgical site infection after colon surgery: National Healthcare Safety Network risk factors and modeled rates compared with published risk factors and rates. J Am Coll Surg 214:852–859CrossRefGoogle Scholar
  24. 24.
    Schietroma M, Cecilia EM, Sista F, Carlei F, Pessia B, Amicucci G (2014) High-concentration supplemental perioperative oxygen and surgical site infection following elective colorectal surgery for rectal cancer: a prospective, randomized, double-blind, controlled, single-site trial. Am J Surg 208:719–726CrossRefGoogle Scholar
  25. 25.
    Anaya DA, Cormier JN, Xing Y, Koller P, Gaido L, Hadfield D, Chemaly RF, Feig BW (2012) Development and validation of a novel stratification tool for identifying cancer patients at increased risk of surgical site infection. Ann Surg 255:134–139CrossRefGoogle Scholar
  26. 26.
    Ejaz A, Schmidt C, Johnston FM, Frank SM, Pawlik TM (2017) Risk factors and prediction model for inpatient surgical site infection after major abdominal surgery. J Surg Res 217:153–159CrossRefGoogle Scholar
  27. 27.
    Mavros MN, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G, Al-Refaie WB, Frank SM, Pawlik TM (2015) Perioperative blood transfusion and the prognosis of pancreatic Cancer surgery: systematic review and meta-analysis. Ann Surg Oncol 22:4382–4391CrossRefGoogle Scholar
  28. 28.
    Vamvakas EC, Blajchman MA (2009) Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 113:3406–3417CrossRefGoogle Scholar
  29. 29.
    Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leao WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr (2010) Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 304:1559–1567CrossRefGoogle Scholar
  30. 30.
    Howard DP, Datta G, Cunnick G, Gatzen C, Huang A (2010) Surgical site infection rate is lower in laparoscopic than open colorectal surgery. Color Dis 12:423–427CrossRefGoogle Scholar
  31. 31.
    Kiran RP, El-Gazzaz GH, Vogel JD, Remzi FH (2010) Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 211:232–238CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departments of Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Department of Surgery, Kangbuk Samsung HospitalSungkyunkwan University School of MedicineSeoulSouth Korea

Personalised recommendations