Shock/Sepsis/Trauma/Critical CareComparative analysis of the incidence of surgical site infections in patients with liver resection for colorectal hepatic metastases after neoadjuvant chemotherapy
Introduction
Postoperative infections are frequent complications and have a significant impact on the length of hospital stay, morbidity, and mortality [1]. Surgical site infections (SSIs) are the most common hospital-acquired infections among surgical patients, with a significant impact on both patient morbidity and health care costs according to the U.S. Centers for Disease Control and Prevention through the National Nosocomial Infections Surveillance program [2].
An SSI is defined as an infection either with incisional involvement of the skin alone or with the involvement of deep tissues or organs. The criteria for defining SSIs are as follows: superficial incisional SSI if only the skin and subcutaneous tissue are involved; deep incisional SSI with the involvement of deep soft tissues, such as fascia and muscles; and organ-space SSI when the organ or space is involved [3]. In recent years, a decreasing incidence of perioperative septic complications has been reported, the result of advances in surgical techniques, new suturing materials, better perioperative management, and the implementation of infection surveillance [4]. Neoadjuvant chemotherapy for colorectal cancer seems to enhance the risk of surgical complications and infections [1], suppressing the hematopoietic system, and causing neutropenia. It is also associated with the risk of life-threatening infections [5].
The aim of this study was to identify the incidence of SSIs and postoperative complications according to the Clavien–Dindo classification, (Table 1) [6], after hepatic resection for metastatic colorectal cancer in patients with and without associated neoadjuvant chemotherapy. The latter are increasingly being used to enlarge the cohort of patients who can be offered hepatic resection for malignancy.
Modern management of colorectal liver metastases is multimodal and incorporates open and laparoscopic surgery, ablative therapies such as radio frequency ablation or microwave ablation, and (neo)adjuvant chemotherapy. Most patients with hepatic metastases should be considered for resectional surgery if all the tumor(s) can be resected, as this offers the only opportunity for prolonged survival.
However, the real impact of these agents on clinical outcomes after hepatic resection remains unclear.
Section snippets
Materials and methods
A total of 181 patients who had undergone hepatic surgery for metastatic colorectal cancer in three surgical units, the Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy, Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele, and Humanitas Centro Catanese di Oncologia, Catania, Italy, between January 2006 and December 2011 were investigated retrospectively. Data were collected on patient age, gender, comorbidities, site of primary
Results
This study enrolled 181 patients with a median age of 63 ± 10 y. There were 103 males (56.9%) and 78 females (43.1%) as shown in Table 2.
The first group (Table 3) included 129 patients without associated chemotherapeutic treatment. The median age was 63 ± 9 y with 74 males (57%) and 55 females (43%). Duration of surgery was estimated at 408 ± 158 min, and all patients underwent an initial time of adhesiolysis, which lengthened the intervention. The total length of hospital stay and length of
Discussion
Surgical resection plays a major role in the treatment of colorectal liver metastases [9]. The safety of this procedure has been established, and several studies have reported satisfactory results with the reported 5-y survival rate after initial hepatectomy in the range of 20%–50% [7].
Liver metastases can be divided into three categories: (1) resectable, (2) not optimally resectable, and (3) unresectable [10], [11]. A recent expert consensus statement recommends that neoadjuvant chemotherapy
Conclusions
To sum up, our study found that neoadjuvant chemotherapy is not a significant risk factor for SSIs or complications according to the Clavien–Dindo classification, and that the total length of hospital stay, length of postoperative hospital stay, and duration of liver surgery were independent predictors of SSIs and complications according to the Clavien–Dindo classification.
Acknowledgment
The authors would like to thank Warren Blumberg of ISMETT's Language Services Department for his help in revising this article.
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