Annals of Surgical Oncology

, Volume 24, Issue 3, pp 721–728 | Cite as

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

  • E. B. ThorgersenEmail author
  • M. A. Goscinski
  • M. Spasojevic
  • A. M. Solbakken
  • A. B. Mariathasan
  • K. Boye
  • S. G. Larsen
  • K. Flatmark
Colorectal Cancer



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.


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.


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.


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.


Overall Survival Surgical Site Infection Circumferential Resection Margin Tumour Regression Grade Perineal Wound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


The authors declare no conflict of interest.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
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Supplementary material 2 (DOCX 17 kb)
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Supplementary material 3 (DOCX 16 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • E. B. Thorgersen
    • 1
    • 2
    Email author
  • M. A. Goscinski
    • 1
  • M. Spasojevic
    • 1
  • A. M. Solbakken
    • 1
  • A. B. Mariathasan
    • 1
  • K. Boye
    • 3
    • 4
  • S. G. Larsen
    • 1
  • K. Flatmark
    • 1
    • 4
    • 5
  1. 1.Department of Gastroenterological SurgeryThe Norwegian Radium Hospital Oslo University HospitalOsloNorway
  2. 2.Institute of ImmunologyOslo University Hospital Rikshospitalet and University of OsloOsloNorway
  3. 3.Department of OncologyThe Norwegian Radium Hospital Oslo University HospitalOsloNorway
  4. 4.Department of Tumour Biology, The Norwegian Radium HospitalOslo University HospitalOsloNorway
  5. 5.Institute of Clinical MedicineUniversity of OsloOsloNorway

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