Abstract
Purpose
Several authors have reported an association between anastomotic leak and/or intra-abdominal abscess and oncological survival and recurrence. However, no reports have investigated whether combining anastomotic leak/intra-abdominal abscess and positive drainage culture influences long-term oncological outcomes. Therefore, we defined these complications as postoperative intra-abdominal infections. The present study aimed to evaluate the prognostic impact of postoperative intra-abdominal infections on long-term oncological outcomes after curative stage I-III colorectal cancer surgery.
Methods
We performed a retrospective analysis of 755 consecutive patients with stage I-III colorectal cancer undergoing curative surgery between 2010 and 2015 by performing a propensity score-matched analysis to reduce selection bias.
Results
Of the 755 patients, 62 were matched for postoperative intra-abdominal infections analyses. The median follow-up was 48 months. Compared with the non-infections group, the postoperative intra-abdominal infections group had a significantly shorter local recurrence-free survival (P = 0.01 prior to matching, and P = 0.05 after matching). No significant difference was found between the groups in terms of overall, cancer-specific free, recurrence-free, or distant recurrence-free survival. However, multivariate analyses identified postoperative intra-abdominal infections as an independent prognostic factor for local recurrence-free survival (P = 0.04 prior to matching, and P = 0.03 after matching).
Conclusions
In this matched-pair analysis comparing stage I-III colorectal cancer patients with and without postoperative intra-abdominal infections, postoperative intra-abdominal infections were associated with poor local recurrence-free survival, but not overall, cancer-specific free, recurrence-free, or distant recurrence-free survival.
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References
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group; MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726
Jannasch O, Klinge T, Otto R et al (2015) Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget 6(34):36884–36893. https://doi.org/10.18632/oncotarget.5170
Zimmermann MS, Wellner U, Laubert T, Ellebrecht DB, Bruch HP, Keck T, Schlöricke E, Benecke CR (2019) Influence of anastomotic leak after elective colorectal cancer resection on survival and local recurrence: a propensity score analysis. Dis Colon Rectum 62(3):286–293. https://doi.org/10.1097/DCR.0000000000001287
Espín E, Ciga MA, Pera M, Ortiz H, Spanish Rectal Cancer Project (2015) Oncological outcome following anastomotic leak in rectal surgery. Br J Surg 102(4):416–422. https://doi.org/10.1002/bjs.9748
Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK (2016) Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum 59(3):236–244. https://doi.org/10.1097/DCR.0000000000000554
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(5):890–899. https://doi.org/10.1097/SLA.0b013e3182128929
Eberhardt JM, Kiran RP, Lavery IC (2009) The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 52(3):380–386. https://doi.org/10.1007/DCR.0b013e31819ad488
Brierley JD, Gospodarowicz MK, Wittekind C (2017) UICC TNM classification of malignant tumors, 8th edn. Wiley, New York
Watanabe T, Muro K, Ajioka Y, Japanese Society for Cancer of the Colon and Rectum et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23(1):1–34. https://doi.org/10.1007/s10147-017-1101-6
Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221(2):176–184
Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48(5):1021–1026
Ha GW, Kim JH, Lee MR (2017) Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol 24(11):3289–3299. https://doi.org/10.1245/s10434-017-5881-8
Jörgren F, Johansson R, Damber L, Lindmark G (2011) Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival? Color Dis 13(3):272–283. https://doi.org/10.1111/j.1463-1318.2009.02136.x
Slanetz CA Jr (1984) The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27(12):792–797
Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN, Norwegian rectal cancer group; Norwegian gastrointestinal cancer group (2004) Inadvertent perforation during rectal cancer resection in Norway. Br J Surg 91(2):210–216
Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M (2011) Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg 15(1):120–129. https://doi.org/10.1007/s11605-010-1379-4
McMillan DC, Wotherspoon HA, Fearon KC, Sturgeon C, Cooke TG, McArdle C (1995) A prospective study of tumor recurrence and acute-phase response after apparently curative colorectal cancer surgery. Am J Surg 170(4):319–332
McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90(7):215–219
Alonso S, Pascual M, Salvans S, Mayol X, Mojal S, Gil MJ, Grande L, Pera M (2015) Postoperative intra-abdominal infection and colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol 41(2):208–214. https://doi.org/10.1016/j.ejso.2014.10.052
Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259
Fermor B, Umpleby HC, Lever JV, Symes MO, Williamson RC (1986) Proliferative and metastatic potential of exfoliated colorectal cancer cells. J Natl Cancer Inst 76(2):347–349
Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357(9255):539–545
Biswas SK, Lopez-Collazo E (2009) Endotoxin tolerance: new mechanisms, molecules and clinical significance. Trends Immunol 30(10):475–487. https://doi.org/10.1016/j.it.2009.07.009
DerHagopian RP, Sugarbaker EV, Ketcham A (1978) Inflammatory oncotaxis. JAMA 240(22):374–375
Shine T, Wallack MK (1981) Inflammatory oncotaxis after testing the skin of the cancer patient. Cancer 47(6):1325–1328
Salvans S, Mayol X, Alonso S, Messeguer R, Pascual M, Mojal S, Grande L, Pera M (2014) Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg 260(5):939–943. https://doi.org/10.1097/SLA.0000000000000958
Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Color Dis 13:160–163
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The Institutional Review Board of Osaka Rosai Hospital approved the study (approval number 31-32). This study was eligible for exemption of informed consent. No animal experiments were performed in this study.
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Sueda, T., Tei, M., Yoshikawa, Y. et al. Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis. Int J Colorectal Dis 35, 413–422 (2020). https://doi.org/10.1007/s00384-019-03493-x
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DOI: https://doi.org/10.1007/s00384-019-03493-x