Schardey Josefine, von Ahnen Thomas, Schardey Emily, Kappenberger Alina, Zimmermann Petra, Kühn Florian, Andrassy Joachim, Werner Jens, Arbogast Helmut, Wirth Ulrich
Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
Institute for Surgical Research Oberbayern, Hausham, Germany.
Front Surg. 2022 May 16;9:874223. doi: 10.3389/fsurg.2022.874223. eCollection 2022.
Anastomotic leakage, surgical site infections, and other infectious complications are still common complications in gastrointestinal surgery. The concept of perioperative antibiotic bowel decontamination demonstrates beneficial effects in single randomized controlled trials (RCTs), but data from routine clinical use are still sparse. Our aim was to analyze the data from the routine clinical use of perioperative antibiotic bowel decontamination in gastrointestinal surgery.
Based on 20 years' experience, we performed a retrospective analysis of all cases in oncologic gastrointestinal surgery with the use of antibiotic bowel decontamination in gastric, sigmoid, and rectal cancer. Clinical data and perioperative outcomes were analyzed, especially regarding anastomotic leakage, surgical site infections, and other infectious complications.
A total of = 477 cases of gastrointestinal surgery in gastric cancer ( = 80), sigmoid cancer ( = 168), and rectal cancer ( = 229) using a perioperative regimen of antibiotic bowel decontamination could be included in this analysis. Overall, anastomotic leakage occurred in 4.4% (2.5% gastric cancer, 3.0% sigmoid cancer, 6.1% rectal cancer) and surgical site infections in 9.6% (6.3% gastric cancer, 9.5% sigmoid cancer, 10.9% rectal cancer). The incidence of all infectious complications was 13.6% (12.5% gastric cancer, 11.3% sigmoid cancer, 15.7% rectal cancer). Mortality was low, with an overall rate of 1.1% (1.3% gastric cancer, 1.8% sigmoid cancer, 0.4% rectal cancer). Antibiotic decontamination was completed in 98.5%. No adverse effects of antibiotic bowel decontamination could be observed.
Overall, in this large cohort, we can report low rates of surgery-related serious morbidity and mortality when perioperative antibiotic bowel decontamination is performed. The rates are lower than other clinical reports. In our clinical experience, the use of perioperative antibiotic bowel decontamination appears to improve patient safety and surgical outcomes during gastrointestinal oncologic procedures in a routine clinical setting.
吻合口漏、手术部位感染及其他感染性并发症仍是胃肠外科常见的并发症。围手术期抗生素肠道去污的概念在单项随机对照试验（RCT）中显示出有益效果，但来自常规临床应用的数据仍然稀少。我们的目的是分析胃肠外科围手术期抗生素肠道去污常规临床应用的数据。
基于20年的经验，我们对所有接受抗生素肠道去污的胃癌、乙状结肠癌和直肠癌肿瘤胃肠外科手术病例进行了回顾性分析。分析临床数据和围手术期结果，尤其关注吻合口漏、手术部位感染及其他感染性并发症。
本分析纳入了共477例使用围手术期抗生素肠道去污方案的胃癌（n = 80）、乙状结肠癌（n = 168）和直肠癌（n = 229）胃肠外科手术病例。总体而言，吻合口漏发生率为4.4%（胃癌2.5%，乙状结肠癌3.0%，直肠癌6.1%），手术部位感染发生率为9.6%（胃癌6.3%，乙状结肠癌9.5%，直肠癌10.9%）。所有感染性并发症的发生率为13.6%（胃癌12.5%，乙状结肠癌11.3%，直肠癌15.7%）。死亡率较低，总体率为1.1%（胃癌1.3%，乙状结肠癌1.8%，直肠癌0.4%）。98.5%的患者完成了抗生素去污。未观察到抗生素肠道去污的不良反应。
总体而言，在这个大型队列中，我们可以报告在进行围手术期抗生素肠道去污时，手术相关的严重发病率和死亡率较低。这些发生率低于其他临床报告。根据我们的临床经验，在常规临床环境中，围手术期使用抗生素肠道去污似乎可提高胃肠肿瘤手术期间的患者安全性和手术效果。
