Postoperative abdominal infections after resection of T4 colon cancer increase the risk of intra-abdominal recurrence. Issue 12 (December 2018)

• Record Type: Journal Article
• Authors: Klaver, Charlotte E.L.; Wasmann, Karin A.T.G.M.; Verstegen, Marlies; van der Bilt, Jarmila D.W.; Nagtegaal, Iris D.; van Ramshorst, Bert; Tanis, Pieter J.; Wolthuis, Albert M.; van Santvoort, Hjalmar C.; de Wilt, Johannes H.W.; D'Hoore, André
• Is Part Of: European journal of surgical oncology. Volume 44:Issue 12(2018)
• Page Start: 1880
• Page End: 1888
• Publication Date: 2018-12
• Subjects: Peritoneal metastases -- Colon cancer -- Postoperative complications -- Surgical site infections (SSI); Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2018.09.016
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Introduction: Patients with pT4 colon cancer are at risk of developing intra-abdominal recurrence. Infectious complications have shown to negatively influence disease free survival (DFS) and overall survival (OS) in stage I-III colon cancer. The aim of this study was to determine whether surgical site infections (SSIs) also increase the risk of intra-abdominal recurrence in pT4 colon cancer patients. Methods: All consecutive patients with pT4N0-2M0 colon cancer from four centres between January 2000 and December 2014 were included. Patients were categorized into 2 groups; with and without a postoperative (<30 days) SSIs. SSIs included both deep incisional as well as organ/space SSIs. The primary outcome was intra-abdominal recurrence (including local/incisional recurrence, peritoneal metastases) and was assessed using Kaplan-Meier and Cox regression analyses. Secondary outcome measures were DFS and OS. Results: Out of 420 patients, 62 (15%) developed a SSI. The 5-year intra-abdominal recurrence rates were 44% and 27% for patients with and without a SSI, respectively (p = 0.011). After multivariate analysis, SSI was independently associated with intra-abdominal recurrence (HR 1.807 (1.091–2.992)), worse DFS (HR 1.788 (1.226–2.607)), and worse OS (HR 1.837 (1.135–2.973)). Other independent risk factors for intra-abdominal recurrence were a R1 resection (HR 2.616 (1.264–5.415)) and N2-stage (HR 2.096 (1.318–3.332)). Conclusion: SSIs after resection of a pT4N0-2M0 colon cancer are associated with an increased risk of intra-abdominal recurrence and worse survival. This finding supports the hypothesis that infection-based immunologic pathways play a role in colon cancer cell dissemination and outgrowth.