POSTOPERATIVE WOUND INFECTION IMPACT ON LONG TERM ONCOLOGICAL OUTCOMES IN RECTAL CANCER PATIENTS

Background. Now there are heteropolar opinions on influence of postoperative purulent septic complications on rectal cancer patients on the long term oncological results.

Objective. Assess influence of these complications following laparotomy and perineal wounds after operations for rectal cancer on the long term oncological results.

Methods. We performed retrospective cohort research of 338 patients undergone scheduled radical operations for middle ampullar and lower ampullar rectal cancer T1-4N0-2M0 from January, 2003 to December, 2011. Patients were distributed in two groups: with suppuration of postoperative wounds and/or abscess of the abdominal cavity (n = 44–13%) and without purulent septic complications (n = 294).

Results. The logit regression analysis has shown that suppuration of laparotomy wounds and/or abscess of the abdominal cavity is one of the independent risk factors of a systemic recurrence. For development of a local recurrence purulent septic complications were not risk factors. The five-year overall and cancer specific survival in compared groups demonstrated statistically significant distinction. The overall survival in the main group – 47%, in the control one – 67.2% (Wilcoxon’s criterion р = 0.10, Cox-Mentela’s criterion р = 0.02, log rank criterion р = 0.03). Cancer specific survival was 43.5% and 70.1% respectively (Wilcoxon’s criterion p = 0.01, Cox-Mentela’s criterion p = 0.005, log rank criterion p = 0.009). The five-year recurrence free survival in the compared groups was similar 50.6 and 69% respectively (Wilcoxon’s criterion p = 0.25, Cox-Mentela’s criterion p= 0.12, log rank criterion p = 0.12).

Conclusion. Purulent septic complications of postoperative wounds in patients with rectal cancer have impact on long term results: they are independent risk factor for systemic recurrence development and decrease total and cancer specific survival rate.

1. Balkwill F, A. Mantovani. Inflammation and cancer: back to Virchow? The Lancet. 2001; 357: 539-545.

2. Serra-Aracil X., Gartia-Domingo M., Parés D., Espin-Basany E., Biondo S., Guirao X., Orrego C., Sitges-Serra A. Arch Surg. Surgical site infection in elective operations for colorectal cancer after the application of preventive measures. 2011; 5(146): 606-612.

3. Weiss C.A., Statz C.L., Dahms R.A., Remucal M.J., Dunn D.L., Beilman G.J. Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Arch Surg. 1999; 10(134): 1041-1048.

4. Kirkland K.B., Briggs J.P., Trivette S.L., Wilkinson W.E., Sexton D.J. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999; 11(20): 725-730.

5. Tang R., Chen H.H., Wang Y.L., Changchien C.R., Chen J.S., Hsu K.C., Chiang J.M. Risk factors for surgical site infection after elective resection of the colon and rectum: a single-center prospective study of 2,809 consecutive patients. Ann Surg. 2001; 2(234): 181-189.

6. Nespoli A., L. Gianotti L., G. Bovo G., Brivio F., Nespoli L., Totis M. Impact of postoperative infections on survival in colon cancer patients. Surg Infect (Larchmt). 2006; 7: 41-3.

7. Coussens L.M., Werb Z. Inflammation and cancer. Nature. 2002; 420: 860-7.

8. Mantovani A., Allavena P., Sica A., Balkwill F. Cancer-related inflammation. Nature. 2008; 454: 436-44.

9. Elaraj D.M., Elaraj D.M., Weinreich D.M., Varghese S., Puhlmann M., S.M. Hewitt S.M., Carroll N.M., Feldman E.D., Turner E.M., Alexander H.R. The role of interleukin

10. in growth and metastasis of human cancer xenografts. Clin Cancer Res. 2006; 4(12): 1088-96.

11. Aggarwal B.B., Vijayalekshmi R.V., Sung B. Targeting inflammatory pathways for prevention and therapy of cancer: short-term friend, long-term foe. Clin Cancer Res. 2009; 2(15): 425-30.

12. Karin M. Nuclear factor-kappaB in cancer development and progression. Nature. 2006; 441: 431-6.

13. Miki C., N. Konishi N., Ojima E., Hatada T., Inoue Y., Kusunoki M. C-reactive protein as a prognostic variable that reflects uncontrolled up-regulation of the IL-1-IL-6 network system in colorectal carcinoma. Dig Dis Sci. 2004; 6(49): 970-6.

14. Wu Y. Zhou В. Inflammation: a driving force speeds cancer metastasis. Cell Cycle. 2009; 8(20): 3267-73.

15. Ланг Т.А., Сесик М.А. Как описывать статистику в медицине. Аннотированное руководство для авторов, редакторов и рецензентов; 2011. С. 35.

16. Халафян А.А. STATISTICA 6. Математическая статистика с элементами теории вероятностей. 2011. 496 с

17. Attie R., Chinen L.T., Yoshioka E.M., Silva M.C., de Lima V.C. Acute bacterial infection negatively impacts cancer specific survival of colorectal cancer patients. World J Gastroenterol. 2014; 38(20): 13930-13935.

18. Langman M.J., Cheng K.K., Gilman E.A., Lancashire R.J. Effect of anti-inflammatory drugs on overall risk of common cancer: case-control study in general practice research database. BMJ. 2000; 320: 1642-1646.

19. Law W.L., Choi H.K., Lee Y.M., Ho J.W. The impact of postoperative complications on long-term outcomes following curative resection for colorectal cancer. Ann Surg Oncol. 2007; 14(9): 2559-66.

20. Tsujimoto H., Ueno Н., Hashiguchi Y., Ono S., Ichikura T., Hase K. Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer. Oncol Lett. 2010; 1(1): 119-125.

21. Mrak K., Eberl T., Laske A., Jagoditsch M., Fritz J., Tschmelitsch J. Impact of postoperative complications on long-term survival after resection for rectal cancer. Dis Colon Rectum. 2013; 56(1): 20-8.