Department of Obstetrics and Gynecology, McMaster University, Ontario, Canada.
Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada.
Gynecol Oncol. 2020 Sep;158(3):597-602. doi: 10.1016/j.ygyno.2020.06.504. Epub 2020 Jul 6.
Bowel procedures are commonly performed as part of ovarian cancer cytoreduction. The aim of this study was to assess the postoperative complication rates among women with an ovarian malignancy undergoing bowel resection/repair at the time of cytoreductive surgery compared with a control group (cytoreductive surgery without bowel resection or repair).
Analysis of 4965 cytoreductive surgeries for suspected ovarian malignancies recorded in the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) datasets (2006-2017) was performed. One-way ANOVA, Kruskal-Wallis H and Chi-squared tests were used to evaluate and compare baseline characteristics between the groups and controls. Postoperative surgical site infection rates and other 30-day post-operative outcomes were assessed with multivariable logistic and linear regressions.
8.3% (413/4965) of cytoreductive procedures had an associated repair of enterotomy (small or large bowel), 10.9% (541/4947) had an associated colectomy with primary anastomosis, and 2.1% (104/4965) had an associated colectomy with colostomy. Surgical site infections (SSI, either superficial incisional, deep incisional, organ space or wound dehiscence) were significantly more prevalent in the bowel resection/repair group (16.9% vs 5.7%, p < 0.0001). The odds of surgical infections were 2.67 times higher in patients who underwent a bowel resection or repair after controlling for age, BMI, ASA status, pre-operative weight loss, hypoalbuminemia, NSQIP morbidity score, length and complexity of surgical procedure.
Patients undergoing bowel resection/repair at the time of cytoreductive surgery are at increased risk of surgical site infections, without increased risk of 30-day mortality. Interventions to mitigate the risk of infectious complications in these patients should be evaluated in a prospective fashion.
肠道手术通常作为卵巢癌减瘤术的一部分进行。本研究旨在评估在细胞减灭术时行肠道切除术/修复术的卵巢恶性肿瘤患者与对照组（无肠道切除或修复的细胞减灭术）相比的术后并发症发生率。
分析美国外科医师学会国家手术质量改进计划（NSQIP）数据库（2006-2017 年）中记录的 4965 例疑似卵巢恶性肿瘤的细胞减灭术。采用单因素方差分析、Kruskal-Wallis H 和卡方检验评估并比较两组和对照组的基线特征。采用多变量逻辑和线性回归评估术后手术部位感染率和其他 30 天术后结局。
4965 例细胞减灭术中，8.3%（413/4965）行肠切开术（小肠或大肠）修补术，10.9%（541/4947）行结肠切除术+一期吻合术，2.1%（104/4965）行结肠切除术+结肠造口术。肠道切除/修复组的手术部位感染（SSI，包括浅表切口、深部切口、器官间隙或伤口裂开）明显更为常见（16.9% vs 5.7%，p<0.0001）。在控制年龄、BMI、ASA 状态、术前体重减轻、低白蛋白血症、NSQIP 发病率评分、手术程序的长度和复杂性后，行肠道切除或修复术的患者发生手术感染的几率增加 2.67 倍。
在细胞减灭术时行肠道切除/修复术的患者发生手术部位感染的风险增加，但 30 天死亡率无增加。应前瞻性评估减轻这些患者感染并发症风险的干预措施。
