Risk factors for organ-space surgical site infections after minimally invasive rectal cancer surgery: a retrospective cohort study

Abstract

Abstract Background The study focused on identifying risk factors for organ-space surgical site infections (SSIs) in patients undergoing minimally invasive rectal cancer surgery and examining the impact of these infections on oncological outcomes. Methods This retrospective study included 1304 patients who underwent either robotic surgery or laparoscopic surgery for rectal cancer. Patients were divided into two groups: those with organ-space SSIs (9.7%, n = 126) and those without organ-space SSIs (n = 1178). Univariate and multivariable analyses were conducted to identify predictors or independent risk factors for organ-space SSI. The post-operative pathological data, short-term outcomes, and oncological prognosis were compared between patients with and without organ-space SSIs. Results The multivariable analysis revealed that males (OR 1.875; 95% CI 1.213–2.896, P = 0.005), conversion to laparotomy (OR 8.428; 95% CI 2.892–24.557, P < 0.001), diabetes (OR 2.013; 95% CI 1.210–3.348, P = 0.007), colonic J pouch (CJP) and transverse coloplasty (TCP) (OR 2.517; 95% CI 1.114–5.687, P = 0.026), and hand-sewn anastomosis (OR 5.194; 95% CI 2.115–12.753, P < 0.001) were identified as independent risk factors for organ-space SSIs. Patients with more risk factors had a higher risk of developing organ-space SSIs (P < 0.001). The risk of organ-space SSI increased with the number of risk factors present: 4.1% in patients without any risk factors, 10.0% in patients with 1 risk factor (RR = 2.571, 95% CI 1.495–4.423), 17.8% in patients with 2 risk factors (RR = 5.022, 95% CI 2.636–9.567), and 62.5% in patients with 3 or 4 risk factors (RR = 38.627, 95% CI 12.571-118.689). There were no significant differences in 3-year OS (94.4% vs. 94.3%, P = 0.712) and DFS (85.6% vs. 86.7%, P = 0.636) between the organ-space SSI and non organ-space SSI groups. However, the organ-space SSI group had a higher incidence of bone metastases compared to the non organ-space SSI group (2.4% vs. 0.4%, P = 0.036). Recurrence rates at other sites, including local recurrence, liver metastases, lung metastases, and peritoneal metastases, did not differ significantly between the two groups. Conclusion This study found that 5 risk factors (male gender, conversion to laparotomy, diabetes, CJP and TCP, and hand-sewn anastomosis) can be used to categorize the likelihood of postoperative organ-space SSI.

Keywords

• Organ-space surgical site infections
• Risk stratification
• Minimally invasive surgery
• Oncologic outcome
• Rectal neoplasm