Faculty Collaboration Database

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. J Gastrointest Surg 2017 Nov;21(11):1813-1820

Date

09/16/2017

Pubmed ID

28913712

Pubmed Central ID

PMC5905431

DOI

10.1007/s11605-017-3571-2

Scopus ID

2-s2.0-85029543026 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

BACKGROUND: Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious 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 extrahepatic biliary 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: Seven hundred twenty-eight 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 postoperative SSI was adversely associated with long-term survival.

Author List

Buettner S, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Weiss M, Fields RC, Krasnick B, Weber SM, Salem A, Martin RCG, Scoggins CR, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Koerkamp BG, Maithel SK, Pawlik TM

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Biliary Tract Neoplasms
Biliary Tract Surgical Procedures
Carcinoma
Cohort Studies
Female
Humans
Incidence
Male
Middle Aged
Neoplasm Recurrence, Local
Prognosis
Proportional Hazards Models
Risk Factors
Surgical Wound Infection
Survival Rate