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Advanced Tumor Stage Is an Independent Risk Factor of Postoperative Infectious Complications After Colorectal Surgery: Arguments From a Case-Matched Series

Bot, Jérôme M.D.1,2; Piessen, Guillaume M.D., Ph.D.1,2,3; Robb, William B. M.D.1,2; Roger, Vianney M.D.4; Mariette, Christophe M.D., Ph.D.1,2,3

Diseases of the Colon & Rectum: May 2013 - Volume 56 - Issue 5 - p 568–576
doi: 10.1097/DCR.0b013e318282e790
Original Contribution: Colorectal/Anal Neoplasia

BACKGROUND: Patient and technical factors influencing postoperative infectious complications after elective colorectal resections for cancer are well described. Tumor related factors, however, have not been extensively evaluated.

OBJECTIVE: This study aimed to measure the effect of tumor stage on postoperative surgical site and extra surgical site infections after elective colorectal cancer resection.

DESIGN: This was a retrospective matched-cohort analysis of prospectively gathered data.

SETTINGS: The study was conducted in a tertiary referral center and a private hospital specializing in colorectal surgery.

PATIENTS: Between 2004 and 2011, 740 consecutive patients underwent elective resection for colorectal cancer in 2 centers. Patients undergoing resection for advanced tumors (group A, ≥stage IIB, n = 177) were matched to randomly selected patients with localized disease (group L, <stage IIB, n = 354). Matching variables were age, sex, American Society of Anesthesiologists score, malnutrition, and surgical approach.

MAIN OUTCOME MEASURES: We compared 30-day infectious complications rates between patients with advanced (group A) and localized (group L) tumors. Multivariable logistic regression analysis was performed to identify risk factors for infectious complications.

RESULTS: Group A had a higher overall rate of IC (44.6 vs 25.4 %, p < 0.001), with a higher risk of infectious complications at both the resection site (p < 0.001) and distant to the resection site (p = 0.015). Independent risk factors for infectious complications were advanced tumors (OR = 2.70; p < 0.001), obesity (OR = 1.89; p = 0.018), malnutrition (OR = 2.22; p = 0.008), and open rather than laparoscopic procedure (OR = 5.11; p < 0.001).

LIMITATIONS: This study is limited by its retrospective methodology.

CONCLUSION: Advanced tumors increase the risk of infectious complications after colorectal resection, with other risk factors including malnutrition, obesity, and resection by laparotomy. Optimization of modifiable risk factors through nutritional repletion and the choice of a minimally invasive operation should be considered.

1Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Lille, France

2University of Lille Nord de France, Lille, France

3Institut National de la Santé et de la Recherche Médicale, Unités Mixtes de Recherche 837, Jean Pierre Aubert Research Center, Team 5 Mucins, Epithelial Differentiation, and Carcinogenesis, Lille, France

4Department of Digestive Surgery, Mathilde Clinic, Rouen, France

Financial Disclosure: None reported.

Jérôme Bot and Guillaume Piessen contributed equally to the work.

Correspondence: Guillaume Piessen, M.D., Ph.D., Department of Digestive and Oncological Surgery, University Hospital Claude Huriez – CHRU – Place de Verdun, 59037 Lille cedex, France. E-mail:

© The ASCRS 2013