Postoperative abdominal infections after resection of T4 colon cancer increase the risk of intra-abdominal recurrence

• Published in: European journal of surgical oncology Vol. 44; no. 12; pp. 1880 - 1888
• Main 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
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.12.2018
• Subjects: Colon cancer; Peritoneal metastases; Postoperative complications; Surgical site infections (SSI); Colon cancer; Peritoneal metastases; Postoperative complications; Surgical site infections (SSI)
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2018.09.016

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. 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. 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)). 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.