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Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM).

Methods

Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI.

Results

Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p = 0.008).

Conclusion

SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.

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Authors and Affiliations

  1. Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands

    Stefan Buettner & Bas Groot Koerkamp

  2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Cecilia G. Ethun & Shishir K. Maithel

  3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George Poultsides & Thuy Tran

  4. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Kamran Idrees & Chelsea A. Isom

  5. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss

  6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Ryan C. Fields & Bradley Krasnick

  7. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber & Ahmed Salem

  8. Department of Surgery, University of Louisville, Louisville, KY, USA

    Robert C. G. Martin & Charles R. Scoggins

  9. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen & Harveshp D. Mogal

  10. Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center, Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH, 43210, USA

    Carl Schmidt, Eliza Beal & Timothy M. Pawlik

  11. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras & Rivfka Shenoy

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  1. Stefan Buettner
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  2. Cecilia G. Ethun
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  15. Harveshp D. Mogal
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  16. Carl Schmidt
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  20. Bas Groot Koerkamp
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Correspondence to Timothy M. Pawlik.

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Buettner, S., Ethun, C.G., Poultsides, G. et al. Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. J Gastrointest Surg 21, 1813–1820 (2017). https://doi.org/10.1007/s11605-017-3571-2

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  • DOI: https://doi.org/10.1007/s11605-017-3571-2

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