Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study

Abstract

The postoperative septic complications in gastrointestinal surgery impact immediate as well as long-term outcomes, which lead to reinterventions and additional costs. The authors presented the experience of three surgery clinics in Romania regarding the specific septic complications occurring in patients operated on for rectal cancer. The study group comprised 2674 patients who underwent surgery over a 5-year period (2017–2021). Neoplasms of the middle and lower rectum (76%) were the majority. There were 85% rectal resections and 15% abdominoperineal excisions of the rectum. In total, 68.54% of patients were operated on laparoscopically, and 31.46% received open surgery. Without taking wound infections into account, 97 (3.67%) patients had abdominal-pelvic septic complications. The aim was to evaluate the causes of the complications. The percentage of suppurations after surgery of the rectum treated by radiochemotherapy was considerably higher than after surgery of the non-radiated upper rectum. The fatality rate was 5.15%. The risk of fistulas was significantly associated with the preoperative treatment, tumour position and type of intervention. Sex, age, TNM stage or grade were not significant at 0.05 the threshold. The risk of fistulas is reduced with low anterior resection, but the gravity of these complications is higher in the lower rectum compared with the superior rectum. Preoperative radiochemotherapy is a contributing factor to septic complications.

A Narrative Literature Review on Sepsis: A Primary Manifestation of Colorectal Neoplasm

“…This microbiota is a contributory element that expedites the development of CRC [ 10 , 37 , 71 , 79 , 80 ]. In the presence of S. bovis septicemia, there was a seven-fold increase in the possibility of having CRC, as reported in the study [ 9 , 75 ]. As published by Glibetic et al, a patient transfused with platelets went into septic shock because the platelets were contaminated by the S. bovis species [ 79 ].…”

“…Numerous studies have pointed to a relatively short list of microorganisms as CRC markers (e.g., S. bovis, S. gallolyticus, C. septicum, and the entire Enterococci family) [ 9 , 11 , 16 , 70 , 74 ]. The recommendation is to continue with the pertinent studies to rule out possible colorectal pathology [ 75 , 76 ].…”

“…S. bovis and its subclasses, types I and II, have been linked to endocarditis, colorectal carcinoma, and biliary tract illnesses [ 10 , 75 , 78 , 79 ]. The relationship between S. bovis and colorectal carcinoma has been well acknowledged recently, mainly including S. gallolyticus bacteria [ 10 , 37 , 71 , 75 , 79 , 80 ].…”

“…S. bovis and its subclasses, types I and II, have been linked to endocarditis, colorectal carcinoma, and biliary tract illnesses [ 10 , 75 , 78 , 79 ]. The relationship between S. bovis and colorectal carcinoma has been well acknowledged recently, mainly including S. gallolyticus bacteria [ 10 , 37 , 71 , 75 , 79 , 80 ]. However, whether the bacteria causes colon cancer or the cancerous lesions cause favorable conditions and a conduit for bacteria to multiply and enter the blood circulation is ambiguous [ 79 ].…”

“…Various studies have also exhibited that bacterial translocation plays a significant role in increasing the incidence of postoperative infections [ 86 ]. However, one study observed that comorbidity and female sex who had non-CRC were mainly related to CRC [ 75 ].…”