Division of Coloproctology, Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-si, South Korea.
PLoS One. 2022 Mar 28;17(3):e0264513. doi: 10.1371/journal.pone.0264513. eCollection 2022.
Minimally invasive surgery is commonly used to treat patients with colorectal cancer, although it can cause surgical site infections (SSIs) that can affect the oncologic outcome. Use of a gentamicin-collagen sponge may help reduce the occurrence of SSIs. We aimed to determine the effectiveness of a gentamicin-collagen sponge in reducing SSIs in minimally invasive surgery for colorectal cancer.
We retrospectively reviewed the records of 310 patients who were diagnosed with colorectal cancer at our hospital and underwent minimally invasive surgery between December 1, 2018, and February 28, 2021. Propensity score matching was conducted with a 1:1 ratio using logistic regression. The primary outcome was the incidence of SSIs in the mini-laparotomy wound. The secondary endpoints were factors affecting the incidence of SSIs.
After propensity score matching, 130 patients were assigned to each group. There were no differences in clinical characteristics between the two groups. SSIs occurred in 2 (1.5%) and 3 (2.3%) patients in the gentamicin-collagen sponge and control groups, respectively (p<0.999). The following factors showed a statistically significant association with SSIs: body mass index >25 kg/m2 (odds ratio, 39.0; 95% confidence interval, 1.90-802.21; p = 0.018), liver disease (odds ratio, 254.8; 95% confidence interval, 10.43-6222.61; p = 0.001), and right hemicolectomy (odds ratio, 36.22; 95% confidence interval, 2.37-554.63; p = 0.010).
Applying a gentamicin-collagen sponge to the mini-laparotomy wound did not reduce the frequency of SSIs. Further studies should be conducted on whether the selective use of gentamicin-collagen sponges may help reduce SSIs in high-risk patients.
微创手术常用于治疗结直肠癌患者，但可能会导致手术部位感染（SSI），从而影响肿瘤学结局。使用庆大霉素-胶原海绵可能有助于降低 SSI 的发生。我们旨在确定庆大霉素-胶原海绵在减少结直肠癌微创手术中 SSI 方面的有效性。
我们回顾性分析了 2018 年 12 月 1 日至 2021 年 2 月 28 日在我院诊断为结直肠癌并接受微创手术的 310 例患者的病历。使用逻辑回归进行 1:1 比例的倾向评分匹配。主要结局是迷你腹腔镜切口的 SSI 发生率。次要终点是影响 SSI 发生率的因素。
倾向评分匹配后，每组各有 130 例患者。两组患者的临床特征无差异。庆大霉素-胶原海绵组和对照组分别有 2（1.5%）和 3（2.3%）例患者发生 SSI（p<0.999）。以下因素与 SSI 显著相关：BMI>25kg/m2（优势比，39.0；95%置信区间，1.90-802.21；p=0.018）、肝病（优势比，254.8；95%置信区间，10.43-6222.61；p=0.001）和右半结肠切除术（优势比，36.22；95%置信区间，2.37-554.63；p=0.010）。
将庆大霉素-胶原海绵应用于迷你腹腔镜切口并不能降低 SSI 的频率。应进一步研究是否选择性使用庆大霉素-胶原海绵有助于降低高危患者的 SSI。
