Kosuga Toshiyuki, Ichikawa Daisuke, Komatsu Shuhei, Kubota Takeshi, Okamoto Kazuma, Konishi Hirotaka, Shiozaki Atsushi, Fujiwara Hitoshi, Otsuji Eigo
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Gastroenterological Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Surg Endosc. 2017 Apr;31(4):1667-1674. doi: 10.1007/s00464-016-5156-7. Epub 2016 Aug 9.
Surgical site infection (SSI), particularly organ/space SSI, remains a clinically important issue even after laparoscopic gastrectomy (LG) for gastric cancer (GC). This study aimed to identify specific clinical and surgical factors associated with organ/space SSI after LG.
This was a retrospective study of 407 patients who underwent LG for clinical stage I GC. SSI was defined according to the National Nosocomial Infection Surveillance System. The incidence and treatment outcomes of either incisional or organ/space SSI after LG were examined, and the risk factors for each type of SSI were identified using univariate and multivariate analyses.
Organ/space SSI was observed in 21 patients (5.2 %), while incisional SSI was detected in 18 patients (4.4 %). Although no mortality was observed, the occurrence of either incisional or organ/space SSI significantly prolonged postoperative hospital stays (p = 0.000 and 0.000, respectively); however, organ/space SSI required more re-operations and re-admissions, and eventually longer total hospital stays than incisional SSI (p = 0.036). Intra-abdominal abscess around the pancreas was the main cause of organ/space SSI, while no anastomotic leakage was observed. Multivariate analyses identified male gender (odds ratio (OR) 3.385; 95 % confidence interval (CI) 1.073-15.07, p = 0.037), chronic liver disease (OR 8.897; 95 % CI 2.502-28.99, p = 0.001), and total gastrectomy (TG) (OR 3.817; 95 % CI 1.380-10.24, p = 0.011) as independent risk factors for organ/space SSI, while TG (OR 3.130; 95 % CI 1.102-8.768, p = 0.033) and operation time ≥320 min (OR 3.732; 95 % CI 1.109-16.98, p = 0.033) were independently associated with incisional SSI.
Male gender, chronic liver disease, and TG are independent risk factors for organ/space SSI after LG for GC; thus, meticulous surgical procedures need to be performed among patients with these specific risk factors.
即使在腹腔镜胃癌切除术（LG）治疗胃癌（GC）后，手术部位感染（SSI），尤其是器官/腔隙性SSI，仍然是一个重要的临床问题。本研究旨在确定LG术后与器官/腔隙性SSI相关的特定临床和手术因素。
这是一项对407例临床I期GC患者行LG的回顾性研究。SSI根据国家医院感染监测系统进行定义。检查LG术后切口或器官/腔隙性SSI的发生率和治疗结果，并通过单因素和多因素分析确定每种类型SSI的危险因素。
21例患者（5.2%）发生器官/腔隙性SSI，18例患者（4.4%）发生切口SSI。虽然未观察到死亡，但切口或器官/腔隙性SSI的发生均显著延长了术后住院时间（分别为p = 0.000和0.000）；然而，器官/腔隙性SSI比切口SSI需要更多的再次手术和再次入院，最终总住院时间更长（p = 0.036）。胰腺周围腹腔脓肿是器官/腔隙性SSI的主要原因，未观察到吻合口漏。多因素分析确定男性（比值比（OR）3.385；95%置信区间（CI）1.073 - 15.07，p = 0.037）、慢性肝病（OR 8.897；95% CI 2.502 - 28.99，p = 0.001）和全胃切除术（TG）（OR 3.817；95% CI 1.380 - 10.24，p = 0.011）是器官/腔隙性SSI的独立危险因素，而TG（OR 3.130；95% CI 1.102 - 8.768，p = 0.033）和手术时间≥320分钟（OR 3.732；95% CI 1.109 - 16.98，p = 0.033）与切口SSI独立相关。
男性、慢性肝病和TG是GC患者LG术后器官/腔隙性SSI的独立危险因素；因此，对于有这些特定危险因素的患者，需要进行细致的手术操作。
