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Annals of Surgical Oncology

, Volume 17, Issue 9, pp 2452–2458 | Cite as

Risk of Postoperative Pelvic Abscess in Major Gynecologic Oncology Surgery: One-Year Single-Institution Experience

  • Anna Fagotti
  • Barbara Costantini
  • Francesco Fanfani
  • Giuseppe Vizzielli
  • Cristiano Rossitto
  • Antonella Lecca
  • Giovanni Scambia
Gynecologic Oncology

Abstract

Purpose

This study was undertaken to evaluate risk factors for the occurrence of postoperative abscesses in a large single-institution series of gynecologic cancer patients undergoing major surgery.

Materials and Methods

Patients admitted to the Division of Gynecologic Oncology, Catholic University of Sacred Hearth, Rome, Italy, between January 2008 and February 2009, were retrospectively analyzed. The occurrence of pelvic abscesses was identified by sign and symptoms and confirmed with radiological and microbiological examinations.

Results

A total of 360 patients were analyzed for the study. Exenteration and use of fibrillar absorbable hemostat were significantly associated with the presence of postoperative abscesses (P < .0001) by multiple regression analysis, whereas operative time, type of surgery, lymphadenectomy, or other associated surgical procedures failed to result statistically relevant.

Conclusions

The use of fibrillar oxidized regenerated cellulose as hemostatic agent may represent a risk factor for postoperative abscesses, especially when used during pelvic exenteration.

Keywords

Bowel Resection Radical Hysterectomy Regenerate Cellulose Vaginal Vault Vaginal Discharge 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

This study is not supported by any grant support. The authors indicate no potential conflicts of interest.

References

  1. 1.
    Kehoe S. Treatments for gynecological cancers. Best Pract Res Clin Obstet Gynaecol. 2006;20:985–1000.CrossRefPubMedGoogle Scholar
  2. 2.
    Chan KK, Naik R. Advances in surgical treatment of cervical cancer. Womens Health (Lond Engl). 2008;4:245–56.Google Scholar
  3. 3.
    Benedetti-Panici P, Maneschi F, Cutillo G, Greggi S, Salerno MG, Amoroso M, et al. G. Modified type IV-V radical hysterectomy with systematic pelvic and aortic lymphadenectomy in the treatment of patients with stage III cervical carcinoma. Feasibility, technique, and clinical results. Cancer. 1996;78:2359–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Van der Burg ME, Vergote I. Gynecological Cancer Group of the EORTC. The role of interval debulking surgery in ovarian cancer. Curr Oncol Rep. 2003;5:473–81.CrossRefPubMedGoogle Scholar
  5. 5.
    Bosze P, Meszaros I, Palfalvi L, Ungar L. Perioperative complications of 116 radical hysterectomies and pelvic node dissections. Eur J Surg Oncol. 1993;19:605–8.PubMedGoogle Scholar
  6. 6.
    Zorlu CG, Aydoğdu T, Ergün Y, Kuşçu E, Cobanoğlu O, Koçak S. Complications of radical hysterectomy: clinical experience of 115 early stage cervical cancers. Gynecol Obstet Invest. 1998;45:137–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Gadducci A, Cosio S, Spirito N, Genazzani AR. The perioperative management of patients with gynaecological cancer undergoing major surgery: a debated clinical challenge. Crit Rev Oncol Hematol. 2010;73:126–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Dicker RC, Greenspan JR, Strauss LT, Cowart MR, Scally MJ, Peterson HB, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. Am J Obstet Gynecol. 1982;144:841–84.PubMedGoogle Scholar
  9. 9.
    Fanning J, Neuhoff RA, Brewer JE, Castaneda T, Marcotte MP, Jacobson RL. Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol. 1998;6:252–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Tanos V, Rojansky N. Prophylactic antibiotics in abdominal hysterectomy. J Am Coll Surg. 1994;179:593–600.PubMedGoogle Scholar
  11. 11.
    Ailawadi M. and Del Priore G. A comparison of thromboembolic prophylaxis in gynecologic oncology patients. Int J Gynecol Cancer. 2001;11:354–8.CrossRefPubMedGoogle Scholar
  12. 12.
    ACOG Committee on Practice Bulletins. Antibiotic prophylaxis for gynecologic procedures. ACOG Practice Bulletin No. 74. Obstet Gynecol. 2006;108:225–34.Google Scholar
  13. 13.
    Oliveira L, Wexner SD, Daniel N, DeMarta D, Weiss EG, Nogueras JJ, et al. Mechanical bowel preparation for elective colorectal surgery. A prospective, randomized, surgeon-blinded trial comparing sodium phosphate and polyethylene glycol-based oral lavage solutions. Dis Colon Rectum. 1997;40:585–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedGoogle Scholar
  15. 15.
    Cox DR. Analysis of binary data. London: Methven; 1970.Google Scholar
  16. 16.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol. 1999;20:250–78.CrossRefPubMedGoogle Scholar
  17. 17.
    Leitao MM Jr, Natenzon A, Abu-Rustum NR, Chi DS, Sonoda Y, Levine DA, et al. Postoperative intra-abdominal collections using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier at the time of laparotomy for ovarian, fallopian tube, or primary peritoneal cancers. Gynecol Oncol. 2009;115:204–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Mazeh H, Samet Y, Abu-Wasel B, Beglaibter N, Grinbaum R, Cohen T, et al. Application of a novel severity grading system for surgical complications after colorectal resection. J Am Coll Surg. 2009;208:355–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Bochner BH, Mc Creath WA, Aubey JJ. Use of ureteroileocecalappendicostomy urinary reservoir in patients with recurrent pelvic malignancies treated with radiation. Gynecol Oncol. 2004;94:140–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Caceres A, Mourton SM, Bochner BH, Gerst SR, Liu L, Alektiar KM, et al. Extended pelvic resections for recurrent uterine and cervical cancer: out-of-the-box surgery. Int J Gynecol Cancer. 2008;18:1139–44.CrossRefPubMedGoogle Scholar
  21. 21.
    Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In vitro antimicrobial activity of oxidized regenerated cellulose against antibiotic-resistant microorganisms. Surg Infect (Larchmt). 2003;4:255–62.CrossRefGoogle Scholar
  22. 22.
    Scher KS, Coil JA Jr. Effects of oxidized cellulose and microfibrillar collagen on infection, Surgery. 1982;91:301–4.PubMedGoogle Scholar
  23. 23.
    Vytrasova J, Tylsova A, Brozkova I, Cervenka L, Pejchalova M, Havelka P. Antimicrobial effect of oxidized cellulose salts. J Indian Microbiol Biotechnol. 2008;35:1247–52.CrossRefPubMedGoogle Scholar
  24. 24.
    Schonauer C, Tessitore E, Barbagallo G, Albanese V, Moraci A. The use of local agents: bone wax, gelatin, collagen, oxidized cellulose. Eur Spine J. 2004;13:S89–96.CrossRefPubMedGoogle Scholar
  25. 25.
    Kothbauer KF, Jallo GI, Siffert J, Jimenez E, Allen JC, Epstein FJ. Foreign body reaction to hemostatic materials mimicking recurrent brain tumor. Report of three cases. J Neurosurg. 2001;95:503–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Gao HW, Lin CK, Yu CP, Yu MS, Chen A. Oxidized cellulose (Surgicel) granuloma mimicking a primary ovarian tumor. Int J Gynecol Pathol. 2002;21:422–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Ereth MH, Schaff M, Ericson EF, Wetjen NM, Nuttall GA, Oliver WC Jr. Comparative safety and efficacy of topical hemostatic agents in a rat neurosurgical model. Neurosurgery. 2008;63:369–72.CrossRefPubMedGoogle Scholar
  28. 28.
    Toglia MR, Pearlman MD. Pelvic fluid collections following hysterectomy and their relation to febrile morbidity. Obstet Gynecol. 1994;83:766–70.PubMedGoogle Scholar
  29. 29.
    Bjorenson JE, Grove HF, List MG Sr, Haasch GC, Austin BP. Effects of hemostatic agents on the pH of body fluids. J Endod. 1986;12:289–92.CrossRefPubMedGoogle Scholar
  30. 30.
    McRitchie DI, Girotti MJ, Glynn MF, Goldberg JM, Rotstein OD. Effect of systemic fibrinogen depletion on intra-abdominal abscess formation. J Lab Clin Med. 1991;118:48–55.PubMedGoogle Scholar
  31. 31.
    Rotstein OD. Role of fibrin deposition in the pathogenesis of intraabdominal infection. Eur J Clin Microbiol Infect Dis. 1992;11:1064–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Reijnen MM, Bleichrodt RP, van Goor H. Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan. Br J Surg. 2003;90:533–41.CrossRefPubMedGoogle Scholar
  33. 33.
    Seyednejad H, Imani M, Jamieson T, Seifalian AM. Topical haemostatic agents. Br J Surg. 2008;95:1197–225.CrossRefPubMedGoogle Scholar
  34. 34.
    Querleu D, Morrow CP. Classification of radical hysterectomy. Gynecol Oncol. 2009;115:314–5; author reply 315–6.Google Scholar

Copyright information

© Society of Surgical Oncology 2010

Authors and Affiliations

  • Anna Fagotti
    • 1
  • Barbara Costantini
    • 1
  • Francesco Fanfani
    • 1
  • Giuseppe Vizzielli
    • 1
  • Cristiano Rossitto
    • 1
  • Antonella Lecca
    • 1
  • Giovanni Scambia
    • 1
  1. 1.Division of Gynecologic OncologyCatholic University of the Sacred HeartRomeItaly

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