Elsevier

Journal of Surgical Research

Volume 244, December 2019, Pages 136-145
Journal of Surgical Research

Gastrointestinal
Impact of a Dual-Ring Wound Protector on Outcome After Elective Surgery for Colorectal Cancer

https://doi.org/10.1016/j.jss.2019.06.014Get rights and content

Abstract

Background

The impact of dual-ring wound protectors (DRWPs) on the long-term outcomes of patients with colorectal cancer (CRC) undergoing elective surgery remains unclear. The aim of this cohort study was to compare short- and long-term outcomes after CRC resection with or without use of a DRWP.

Methods

This study enrolled 625 patients with stage I–III CRC undergoing curative resection and divided them into DRWP (n = 348) and control (n = 277) groups. Primary endpoints were postoperative short- and long-term complications. Secondary endpoints were oncological outcomes including wound recurrence, disease-free survival, and overall survival.

Results

Rates of postoperative complications (P = 0.004) and laparotomy wound infection (LWI) (P < 0.001) were markedly lower in the DRWP group. Operation quality, as per the number of lymph nodes harvested and rate of R0 resection, did not differ between the groups (all P > 0.05). The DRWP group exhibited significantly lower rates of incisional hernia occurrence (5.3% versus 9.5%, P = 0.045) compared with the control group. Multivariable analyses demonstrated an increased risk of LWI with no wound protector in colorectal surgery (odds ratio, 3.778; P = 0.001), and patients who developed LWI after surgery were more than 4 times more likely to develop an incisional hernia during outpatient follow-up (odds ratio, 4.333; P = 0.001). One patient in the control group (0.36%) had isolated wound recurrence at 12 mo postoperatively.

Conclusions

Fewer postoperative and late complications, comparable oncological safety, and similar long-term clinical outcomes confirmed the benefits of DRWP use for patients with CRC undergoing elective surgery. Therefore, the use of DRWP may be considered in curative CRC resection.

Introduction

Surgical site infection (SSI) is a major problem after surgery and is the second most frequent health care–associated infection in Europe and the United States.1, 2 SSI occurrence leads to sepsis, prolonged hospitalization, increased health care–related costs, and ultimately postoperative mortality.3, 4, 5 Higher rates of SSI have been reported in colorectal surgery (CRS) compared with other operations.6, 7 Therefore, medical devices to prevent SSI are of great medical and economic importance.

The benefit of dual-ring wound protectors (DRWPs) in decreasing SSI rate after CRS has been well documented in the past decade.1, 8, 9, 10 However, little data exist pertaining to the long-term outcomes of patients undergoing colorectal cancer (CRC) resection with or without use of a DRWP. Therefore, this cohort study was conducted, with the primary endpoints being short- and long-term complications after CRC resection with or without use of a DRWP. The secondary endpoints were oncological outcomes including wound recurrence, disease-free survival (DFS), and overall survival (OS).

Section snippets

Materials and methods

The study included consecutive patients who underwent elective resection of primary CRC at a single institution from January 2005 to April 2014. The institutional review board of our hospital approved this study (KMUH-IRB-2012-03-02). Exclusion criteria were (1) nonconsent to the procedure, (2) local resection, (3) urgent surgery, (4) abdominoperineal resection for rectal cancer, and (5) without preoperative mechanical bowel preparation. The physical status of the patient is accessed via the

Results

In total, 625 patients underwent curative CRC resection at the institution between January 2005 and April 2014. Of these patients, 625 were included in this study (Fig. 1). The study population included 360 men (57.6%), and the median age was 66 y (range, 20-92 y). Of the 625 patients, 348 (55.7%) were enrolled in the DRWP group and 277 were enrolled in the control group. Table 1 shows the demographic characteristics of the enrolled patients. The percentage of patients with rectal cancer is

Discussion

Although several studies have assessed the efficacy of DRWPs in prevention of SSI after CRS, the majority of such studies had small sample sizes and included patients with both benign and malignant colorectal diseases.8, 9, 10 The present study included 625 patients with stage I–III CRC and investigated the short- and long-term outcomes of DRWP use in elective CRC surgery. The findings support the safety and efficacy of DRWP use in CRS.

The rate of SSI after CRS was significantly lower in the

Conclusion

Our findings demonstrate the benefits of DRWPs for patients with CRC undergoing surgery, as indicated by the favorable short-term outcomes, fewer late complications, and similar long-term clinical outcomes. Therefore, DRWP use should be considered for patients undergoing surgical CRC resection.

Acknowledgment

The authors thank the contribution to data collection made by the Colorectal Cancer Group from the Cancer Center of Kaohsiung Medical University Chung-Ho Memorial Hospital. This work was supported by grants through funding from the Ministry of Science and Technology (MOST108-2321-B-037-001, MOST107-2321-B-037-003, MOST107-2314-B-037-116, MOST107-2314-B-037-022-MY2, MOST107-2314-B-037-023-MY2) and the Ministry of Health and Welfare (MOHW107-TDU-B-212-123006, MOHW107-TDU-B-212-114026B,

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