Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

Lawler, Jack; Choynowski, Michelle; Bailey, Katie; Bucholc, Magda; Johnston, Alison; Sugrue, Michael

doi:10.1002/bjs5.50302

Cited by 54 publications

(27 citation statements)

References 71 publications

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“…Anastomotic leakage has a significant negative impact on disease-free survival, overall survival and local recurrence [ 5 , 6 ]. A meta-analysis including a total of 154,981 patients showed that anastomotic leakage had a negative impact on overall survival [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Zarnescu

Costea

2021

Diagnostics

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Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.

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Section: Introductionmentioning

confidence: 99%

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Zarnescu

Costea

2021

Diagnostics

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“…In addition, inflammation caused by AL contributes to tumor escape immune surveillance by suppressing T cell [ 14 , 15 ]. Several meta-analyses have shown that AL decreases overall survival and disease-free survival and increases the risk of cancer-related death in rectal cancer patients [ 16 – 18 ]. Many factors may affect postoperative complications, including age, sex, tumor location, and diabetes mellitus [ 19 – 21 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

Yang

Luo

Tian³

et al. 2022

Journal of Oncology

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Objective. Neoadjuvant radiotherapy (nRT) is an important treatment approach for rectal cancer. The relationship, however, between nRT and postoperative complications is still controversial. Here, we conducted a meta-analysis to evaluate such concerns. Methods. The electronic literature from 1983 to 2021 was searched in PubMed, Embase, and Web of Science. Postoperative complications after nRT were included in the meta-analysis. The pooled odds ratio (OR) was calculated by the random-effects model. Statistical analysis was conducted by Review Manager 5.3 and STATA 14. Results. A total of 23,723 patients from 49 studies were included in the meta-analysis. The pooled results showed that nRT increased the risk of anastomotic leakage (AL) compared to upfront surgery (OR = 1.23; 95% CI, 1.07–1.41; p = 0.004 ). Subgroup analysis suggested that both long-course (OR = 1.20, 95% CI 1.03–1.40; p = 0.02 ) and short-course radiotherapy (OR = 1.25, 95% CI, 1.02–1.53; p = 0.04 ) increased the incidence of AL. In addition, nRT was the main risk factor for wound infection and pelvic abscess. The pooled data in randomized controlled trials, however, indicated that nRT was not associated with AL (OR = 1.01; 95% CI 0.82–1.26; p = 0.91 ). Conclusions. nRT may increase the risk of AL, wound infection, and pelvic abscess compared to upfront surgery among patients with rectal cancer.

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“…Increasingly, performance improvement programmes are focusing on optimising laparotomy outcomes in order to reduce morbidity and mortality, particularly in relation to surgical site infection [ 4 , 5 ]. SSIs are not only a source of both inconvenience and added cost, but they may also result in adverse oncological outcomes [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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Meta-analysis of the impact of postoperative infective complications on oncological outcomes in colorectal cancer surgery

Cited by 54 publications

References 71 publications

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Effects of Neoadjuvant Radiotherapy on Postoperative Complications in Rectal Cancer: A Meta-Analysis

Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

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