Influence of combined mechanical-chemical versus mechanical bowel preparation on anastomotic leak and surgical site infections after elective resection of left colon cancer

Abstract

Background: Mechanical bowel preparation (MBP) before elective resection of left colon cancer remains controversial. We propose that the protective effect of MBP is dependent on its combination with chemical preparation by oral antibiotics.Methods: Medical data of adult patients with left colon cancer who underwent elective resection at Sohag University Hospital (August 2016-March 2019) were reviewed. Anastomotic leak (AL), surgical site infections (SSI), postoperative morbidity and mortality were compared among patients who preoperatively received MBP followed by chemical preparation with oral antibiotics (MBP and OABx group) versus another group of preoperative MPB alone (MBP group).Results: Forty-two patients with left colon adenocarcinoma were enrolled, 21 per group. Overall, sigmoid colon was the most common site of left sided colon cancer (76%). Malignant lesions were found in proximal sigmoid in 19 (45%), rectosigmoid in 13 (31%), descending colon in 8 (19%) and splenic flexure in 2 (5%) patients. Dukes’ classification was A in 6 (14%), B in 19 (45%) and C in 17 (41%) patients. Compared with MBP, MBP and OABx group showed significantly lower rates of anastomotic leak (3 patients (14%) versus 1 (5%) respectively, p<0.05) and surgical site and intraabdominal infections (7 patients (33%) versus 2 (10%), p<0.05). MBP and OABx group exhibited lesser grades of postoperative complications (p<0.05) and shorter hospital stay (p<0.05). Postoperative mortality occurred only in the MBP group.Conclusions: Combined mechanical-chemical bowel preparation prior to elective resection of left colon cancer confers superior clinical outcome regarding anastomotic leak, surgical site infections and overall postoperative complications.

Feasibility and safety of liver resection for huge hepatocellular carcinoma in cirrhotics

“…To simplify the ranking process, complication score in each patient was concluded via assigning one points to each complication level in ascending order. 16 We found that cirrhotic patients who had major resections (all in the huge HCC group) developed more serious complications and required longer periods of hospital stay. These findings were in agreement with previous studies which showed increased postoperative complications following huge HCC ≥10 cm resection in cirrhotics compared with those with smaller HCCs.…”

“…As we previously described, severity of postoperative complications was assessed by Clavien-Dindo system, with conclusion of postoperative complication score (ranging from one to seven) by assigning one point to each of the seven complication grades I, II, IIIa, IIIb, IVa, IVb and V in ascending order. 15,16…”

Clinical outcome of hepatic resection for malignant liver tumors in elderly patients

“…26,30 The severity of postoperative complications was objectively assessed by Clavien-Dindo system and our proposed scoring of grades of surgical complications. 21 In contrast to the non-elderly group, elderly patients, particularly cirrhotics, exhibited significantly higher complication score. This might be reasonably attributed to the poorer quality of liver parenchyma due to aging.…”

“…Furthermore, severity of postoperative complications was assessed by Clavien-Dindo system. 21 Moreover, as we have previously described, each patient was given a postoperative score of complications (from one to seven) through assigning one point the seven grades which have been described in this system (I, II, IIIa, IIIb, IVa, IVb and V) in ascending order. 21 Mortality during the initial postoperative 30 days following liver resection, was considered as hepatectomy-related postoperative death, even if occurred after discharge from the hospital.…”