Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis

  • 79 Accesses



Several authors have reported an association between anastomotic leak and/or intra-abdominal abscess and oncological survival and recurrence. However, no reports have investigated whether combining anastomotic leak/intra-abdominal abscess and positive drainage culture influences long-term oncological outcomes. Therefore, we defined these complications as postoperative intra-abdominal infections. The present study aimed to evaluate the prognostic impact of postoperative intra-abdominal infections on long-term oncological outcomes after curative stage I-III colorectal cancer surgery.


We performed a retrospective analysis of 755 consecutive patients with stage I-III colorectal cancer undergoing curative surgery between 2010 and 2015 by performing a propensity score-matched analysis to reduce selection bias.


Of the 755 patients, 62 were matched for postoperative intra-abdominal infections analyses. The median follow-up was 48 months. Compared with the non-infections group, the postoperative intra-abdominal infections group had a significantly shorter local recurrence-free survival (P = 0.01 prior to matching, and P = 0.05 after matching). No significant difference was found between the groups in terms of overall, cancer-specific free, recurrence-free, or distant recurrence-free survival. However, multivariate analyses identified postoperative intra-abdominal infections as an independent prognostic factor for local recurrence-free survival (P = 0.04 prior to matching, and P = 0.03 after matching).


In this matched-pair analysis comparing stage I-III colorectal cancer patients with and without postoperative intra-abdominal infections, postoperative intra-abdominal infections were associated with poor local recurrence-free survival, but not overall, cancer-specific free, recurrence-free, or distant recurrence-free survival.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM, MRC CLASICC trial group; MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–1726

  2. 2.

    Jannasch O, Klinge T, Otto R et al (2015) Risk factors, short and long term outcome of anastomotic leaks in rectal cancer. Oncotarget 6(34):36884–36893. https://doi.org/10.18632/oncotarget.5170

  3. 3.

    Zimmermann MS, Wellner U, Laubert T, Ellebrecht DB, Bruch HP, Keck T, Schlöricke E, Benecke CR (2019) Influence of anastomotic leak after elective colorectal cancer resection on survival and local recurrence: a propensity score analysis. Dis Colon Rectum 62(3):286–293. https://doi.org/10.1097/DCR.0000000000001287

  4. 4.

    Espín E, Ciga MA, Pera M, Ortiz H, Spanish Rectal Cancer Project (2015) Oncological outcome following anastomotic leak in rectal surgery. Br J Surg 102(4):416–422. https://doi.org/10.1002/bjs.9748

  5. 5.

    Lu ZR, Rajendran N, Lynch AC, Heriot AG, Warrier SK (2016) Anastomotic leaks after restorative resections for rectal cancer compromise cancer outcomes and survival. Dis Colon Rectum 59(3):236–244. https://doi.org/10.1097/DCR.0000000000000554

  6. 6.

    Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P (2011) Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 253(5):890–899. https://doi.org/10.1097/SLA.0b013e3182128929

  7. 7.

    Eberhardt JM, Kiran RP, Lavery IC (2009) The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 52(3):380–386. https://doi.org/10.1007/DCR.0b013e31819ad488

  8. 8.

    Brierley JD, Gospodarowicz MK, Wittekind C (2017) UICC TNM classification of malignant tumors, 8th edn. Wiley, New York

  9. 9.

    Watanabe T, Muro K, Ajioka Y, Japanese Society for Cancer of the Colon and Rectum et al (2018) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol 23(1):1–34. https://doi.org/10.1007/s10147-017-1101-6

  10. 10.

    Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 221(2):176–184

  11. 11.

    Branagan G, Finnis D, Wessex Colorectal Cancer Audit Working Group (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48(5):1021–1026

  12. 12.

    Ha GW, Kim JH, Lee MR (2017) Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol 24(11):3289–3299. https://doi.org/10.1245/s10434-017-5881-8

  13. 13.

    Jörgren F, Johansson R, Damber L, Lindmark G (2011) Anastomotic leakage after surgery for rectal cancer: a risk factor for local recurrence, distant metastasis and reduced cancer-specific survival? Color Dis 13(3):272–283. https://doi.org/10.1111/j.1463-1318.2009.02136.x

  14. 14.

    Slanetz CA Jr (1984) The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27(12):792–797

  15. 15.

    Eriksen MT, Wibe A, Syse A, Haffner J, Wiig JN, Norwegian rectal cancer group; Norwegian gastrointestinal cancer group (2004) Inadvertent perforation during rectal cancer resection in Norway. Br J Surg 91(2):210–216

  16. 16.

    Katoh H, Yamashita K, Wang G, Sato T, Nakamura T, Watanabe M (2011) Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg 15(1):120–129. https://doi.org/10.1007/s11605-010-1379-4

  17. 17.

    McMillan DC, Wotherspoon HA, Fearon KC, Sturgeon C, Cooke TG, McArdle C (1995) A prospective study of tumor recurrence and acute-phase response after apparently curative colorectal cancer surgery. Am J Surg 170(4):319–332

  18. 18.

    McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90(7):215–219

  19. 19.

    Alonso S, Pascual M, Salvans S, Mayol X, Mojal S, Gil MJ, Grande L, Pera M (2015) Postoperative intra-abdominal infection and colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol 41(2):208–214. https://doi.org/10.1016/j.ejso.2014.10.052

  20. 20.

    Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, Bokey EL (2004) Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2):255–259

  21. 21.

    Fermor B, Umpleby HC, Lever JV, Symes MO, Williamson RC (1986) Proliferative and metastatic potential of exfoliated colorectal cancer cells. J Natl Cancer Inst 76(2):347–349

  22. 22.

    Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357(9255):539–545

  23. 23.

    Biswas SK, Lopez-Collazo E (2009) Endotoxin tolerance: new mechanisms, molecules and clinical significance. Trends Immunol 30(10):475–487. https://doi.org/10.1016/j.it.2009.07.009

  24. 24.

    DerHagopian RP, Sugarbaker EV, Ketcham A (1978) Inflammatory oncotaxis. JAMA 240(22):374–375

  25. 25.

    Shine T, Wallack MK (1981) Inflammatory oncotaxis after testing the skin of the cancer patient. Cancer 47(6):1325–1328

  26. 26.

    Salvans S, Mayol X, Alonso S, Messeguer R, Pascual M, Mojal S, Grande L, Pera M (2014) Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg 260(5):939–943. https://doi.org/10.1097/SLA.0000000000000958

  27. 27.

    Petersen S, Freitag M, Hellmich G, Ludwig K (1998) Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Color Dis 13:160–163

Download references

Author information

Correspondence to Toshinori Sueda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval and informed consent

The Institutional Review Board of Osaka Rosai Hospital approved the study (approval number 31-32). This study was eligible for exemption of informed consent. No animal experiments were performed in this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material


(DOCX 65 kb).

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sueda, T., Tei, M., Yoshikawa, Y. et al. Prognostic impact of postoperative intra-abdominal infections after elective colorectal cancer resection on survival and local recurrence: a propensity score-matched analysis. Int J Colorectal Dis 35, 413–422 (2020). https://doi.org/10.1007/s00384-019-03493-x

Download citation


  • Colorectal cancer
  • Postoperative intra-abdominal infections
  • Propensity score-matching
  • Oncological outcomes
  • Local recurrence