Huang Wang, Wei Zheng-Qiang, Qiu Yu-Hao, Tang Gang, Sun Hao
Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Oncol. 2023 Jan 4;12:1036241. doi: 10.3389/fonc.2022.1036241. eCollection 2022.
In two facilities in Chongqing, this research sought to retrospectively evaluate the effects of perineal wound infection on survival after laparoscopic abdominoperineal resection (LAPR) of rectal cancer.
To obtain clinical information on patients who underwent LAPR between January 2013 and December 2021, we performed a multicenter cohort study. A total of 473 patients were enrolled: 314 in the non-infection group and 159 in the group with perineal infection. The general data, perioperative conditions, and tumor outcomes between groups were analyzed. The infection rates, recurrence rates, and survival rates of the two centers were compared.
The age, height, weight, body mass index (BMI), preoperative complications, preoperative treatment, and intraoperative conditions of patients in the LAPR infection group were not statistically different from those in the non-infection group. The percentage of men, typical postoperative hospital stay, length of initial postoperative therapy, and recurrence and metastasis rates were all considerably higher in the infection group than those in the non-infection group. Wound infection was an independent factor affecting tumor recurrence and metastasis after LAPR as well as an independent factor shortening patient survival time according to multivariate analysis. The incidence of wound infection, the rate of recurrence, and the rate of mortality did not vary significantly across sites.
Wound infection after LAPR increases the mean postoperative hospital stay, prolongs the time to first postoperative treatment, and decreases the disease-free survival (DFS) and overall survival (OS). Therefore, decreasing the rate of LAPR wound infection is expected to shorten the postoperative hospital stay and prolong the patient DFS and OS. Patients with postoperative infection may require intensive adjuvant therapy.
本研究旨在回顾性评估重庆两家医疗机构中会阴伤口感染对直肠癌腹腔镜腹会阴联合切除术（LAPR）后生存的影响。
为获取2013年1月至2021年12月期间接受LAPR患者的临床信息，我们开展了一项多中心队列研究。共纳入473例患者：非感染组314例，会阴感染组159例。分析了两组之间的一般资料、围手术期情况和肿瘤结局。比较了两个中心的感染率、复发率和生存率。
LAPR感染组患者的年龄、身高、体重、体重指数（BMI）、术前并发症、术前治疗及术中情况与非感染组相比，差异无统计学意义。感染组男性比例、术后平均住院时间、首次术后治疗时长以及复发转移率均显著高于非感染组。多因素分析显示，伤口感染是影响LAPR术后肿瘤复发转移的独立因素，也是缩短患者生存时间的独立因素。各中心伤口感染发生率、复发率和死亡率差异无统计学意义。
LAPR术后伤口感染会延长术后平均住院时间，延长首次术后治疗时间，降低无病生存期（DFS）和总生存期（OS）。因此降低LAPR伤口感染率有望缩短术后住院时间，延长患者DFS和OS。术后感染患者可能需要强化辅助治疗。
