Risk factors for organ-space surgical site infections after minimally invasive rectal cancer surgery: a retrospective cohort study.

Abstract

Background: The study focused on identifying risk factors for organ-space surgical site infections (SSIs) in patients undergoing minimally invasive rectal cancer surgery and examining the impact of these infections on oncological outcomes.

Methods: This retrospective study included 1304 patients who underwent either robotic surgery or laparoscopic surgery for rectal cancer. Patients were divided into two groups: those with organ-space SSIs (9.7%, n = 126) and those without organ-space SSIs (n = 1178). Univariate and multivariable analyses were conducted to identify predictors or independent risk factors for organ-space SSI. The post-operative pathological data, short-term outcomes, and oncological prognosis were compared between patients with and without organ-space SSIs.

Results: The multivariable analysis revealed that males (OR 1.875; 95% CI 1.213-2.896, P = 0.005), conversion to laparotomy (OR 8.428; 95% CI 2.892-24.557, P < 0.001), diabetes (OR 2.013; 95% CI 1.210-3.348, P = 0.007), colonic J pouch (CJP) and transverse coloplasty (TCP) (OR 2.517; 95% CI 1.114-5.687, P = 0.026), and hand-sewn anastomosis (OR 5.194; 95% CI 2.115-12.753, P < 0.001) were identified as independent risk factors for organ-space SSIs. Patients with more risk factors had a higher risk of developing organ-space SSIs (P < 0.001). The risk of organ-space SSI increased with the number of risk factors present: 4.1% in patients without any risk factors, 10.0% in patients with 1 risk factor (RR = 2.571, 95% CI 1.495-4.423), 17.8% in patients with 2 risk factors (RR = 5.022, 95% CI 2.636-9.567), and 62.5% in patients with 3 or 4 risk factors (RR = 38.627, 95% CI 12.571-118.689). There were no significant differences in 3-year OS (94.4% vs. 94.3%, P = 0.712) and DFS (85.6% vs. 86.7%, P = 0.636) between the organ-space SSI and non organ-space SSI groups. However, the organ-space SSI group had a higher incidence of bone metastases compared to the non organ-space SSI group (2.4% vs. 0.4%, P = 0.036). Recurrence rates at other sites, including local recurrence, liver metastases, lung metastases, and peritoneal metastases, did not differ significantly between the two groups.

Conclusion: This study found that 5 risk factors (male gender, conversion to laparotomy, diabetes, CJP and TCP, and hand-sewn anastomosis) can be used to categorize the likelihood of postoperative organ-space SSI.