Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Abstract

Background Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extra-hepatic bilary malignancies (EHBM). Methods Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results 728 patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection liver resection was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n=70, 9.6%) or formation of an abscess in the operative bed (n=91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p=0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p=0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p=0.008). Conclusion SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of post-operative SSI was adversely associated with long-term survival.

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base

“…Independent prognostic factors include hepatic invasion, lymph node metastasis, and surgical margin status 9,11‐13 . Specifically, lymph node status is a strong predictor of OS 9,11 .…”

Impact of type and severity of postoperative complications on long‐term outcomes after colorectal liver metastases resection

“…Infective postoperative complications (Inf‐POC) included respiratory tract infection, catheter‐related bloodstream infection, urinary tract infection, and surgical site infection (intraabdominal collection, wound infection or biliary fistula). To be diagnosed with Inf‐POC, patients had to present clinical systemic (such as fever) or local (such as local pain or swelling) symptoms; and/or compatible diagnostic imaging; and/or isolation of microorganisms in body fluids or tissues 15 . Noninfective postoperative complications (Non‐inf POC) included paralytic ileus, liver failure, renal failure, postoperative hemorrhage, pulmonary (noninfective), and cardiac complications.…”

Negative pressure wound therapy (NPWT) on closed incisions to prevent surgical site infection in high-risk patients in hepatopancreatobiliary surgery: study protocol for a randomized controlled trial—the NP-SSI trial

“…Moreover, a direct influence on the overall outcome for the patient has been demonstrated. Buettner et al showed a deterioration of recurrence-free survival and overall survival after curative-intended resections of extrahepatic bile duct malignancies [ 9 ]. Furthermore, similar results have been shown in cases of hepatic resection of colorectal liver metastases [ 10 ].…”

“…SSIs account for a large proportion of nosocomial infections [ 3 , 4 ] and often lead to revision operations [ 5 ], prolonged hospital stays, increased costs [ 6 , 7 ], and a reduction in patient quality of life [ 8 ]. In addition, they have been shown to worsen the overall outcome in oncological patients [ 9 , 10 ].…”