Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis

• Published in: International journal of colorectal disease Vol. 35; no. 3; pp. 413 - 422
• Main Authors: Sueda, Toshinori, Tei, Mitsuyoshi, Yoshikawa, Yukihiro, Furukawa, Haruna, Matsumura, Tae, Koga, Chikato, Wakasugi, Masaki, Miyagaki, Hiromichi, Kawabata, Ryohei, Tsujie, Masanori, Hasegawa, Junichi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2020; Springer
• Subjects: Abdomen; Abscess; Colorectal cancer; Complications and side effects; Diseases; Gastroenterology; Hepatology; Infection; Internal Medicine; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Original Article; Proctology; Relapse; Surgery; Oncological outcomes; Postoperative intra-abdominal infections; Local recurrence; Colorectal cancer; Propensity score-matching
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-019-03493-x

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.