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Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer

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Abstract

Background

Recurrence occurs in up to 20% of patients with stage II colon cancer operated on for cure. Although postoperative intra-abdominal infection has been linked with an increased risk of recurrence, the association is controversial. The aim was to investigate the impact of postoperative intra-abdominal infection on disease-free survival and disease-specific survival in patients with stage II colon cancer.

Methods

Patients undergoing elective surgery for colon cancer stage II, between 2003 and 2014, were included. Patients with anastomotic leak or intra-abdominal abscess were included in the infection group. We used the Kaplan–Meier method to represent the distribution of survival and the Cox proportional hazards model to estimate the contribution of relevant clinicopathological factors with prognosis.

Results

Postoperative intra-abdominal infection was diagnosed in 37 of 363 (10.2%) patients. Perioperative blood transfusion was more frequent in patients with infection (p = 0.008). Overall 5-year disease-free survival rate was 85.1%. Disease-free survival at 5 years was lower in patients with postoperative intra-abdominal infection (52.8 vs 88.7%; p < 0.001), perineural invasion (p = 0.001), lymphovascular invasion (p = 0.001), pT4 (p = 0.013), and in patients with adjuvant chemotherapy (p = 0.013). Multivariate analysis showed that postoperative intra-abdominal infection (HR 4.275; p < 0.001), perineural invasion (HR 2.230; p = 0.007), and lymphovascular invasion (HR 2.052; p = 0.016) were all significant independent predictors of reduced disease-free survival. Regarding specific survival, independent significant prognostic factors were the number of lymph nodes, lymphovascular invasion, and postoperative intra-abdominal infection.

Conclusion

In this series of patients with stage II colon cancer, postoperative intra-abdominal infection has an independent negative impact on disease-free survival and disease-specific survival.

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Funding

Supported by research Grant from Instituto de Salud Carlos III (FIS Grant PI11/01093).

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Authors and Affiliations

  1. Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain

    P. Sánchez-Velázquez, M. Pera, M. Jiménez-Toscano, X. Rogés & L. Lorente

  2. Colorectal Cancer Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    P. Sánchez-Velázquez, M. Pera, M. Jiménez-Toscano & X. Mayol

  3. Department of Pathology, Hospital del Mar, Barcelona, Spain

    M. Iglesias

  4. Department of Medical Oncology, Hospital del Mar, Barcelona, Spain

    M. Gallén

Authors
  1. P. Sánchez-Velázquez
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  2. M. Pera
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  3. M. Jiménez-Toscano
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  4. X. Mayol
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  5. X. Rogés
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  6. L. Lorente
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Correspondence to M. Pera.

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The author declares that there is no competing interest.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The Hospital del Mar Institutional Review Board does not require formal informed consent for retrospective studies including only chart review. Complete patient anonymity is guaranteed.

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Sánchez-Velázquez, P., Pera, M., Jiménez-Toscano, M. et al. Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer. Clin Transl Oncol 20, 1321–1328 (2018). https://doi.org/10.1007/s12094-018-1866-8

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  • DOI: https://doi.org/10.1007/s12094-018-1866-8

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