Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands.
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
J Gastrointest Surg. 2023 Aug;27(8):1685-1693. doi: 10.1007/s11605-023-05746-1. Epub 2023 Jul 5.
Oral antibiotics (OAB) in colorectal surgery have been shown to reduce surgical site infections (SSIs) and possibly anastomotic leakage. However, evidence on long-term follow-up, reintervention rates and 5-year oncological follow-up is lacking. The current study aims at elucidating this knowledge gap.
This study evaluated the long-term effectiveness of perioperative 'Selective decontamination of the digestive tract' (SDD) in colorectal cancer surgery. The primary outcome was anastomotic leakage within 90 days, secondary outcomes included infectious complications, reinterventions, readmission, hospital stay, and 5-year overall and disease-free-survival. Statistical analysis including univariate and multivariate analysis was performed to identify predictors of 90-day outcomes, and Kaplan-Meier survival analysis was used for the 5-year survival outcomes.
In total 455 patients were analyzed, 228 participants in the SDD group and 227 in the control group. Anastomotic leakage rate was not statistically different between the SDD and control group (6.6% versus 9.7%). One or more infectious complications occurred in 15.4% of patients in the SDD group and in 28.2% in the control group (OR 0.46, 95% C.I. 0.29 - 0.73). In the SDD group 8,8% of patients required a reintervention compared to 16,3% of patients in the control group (OR 0.47, 95% C.I. 0.26 - 0.84). After multivariable analysis SDD remained significant in reducing both infectious complications and reinterventions after 90-days follow-up. There was no difference between SDD and control group in 5-year overall survival and disease-free-survival.
SDD as OAB is effective in reducing 90-days postoperative infectious complications and reinterventions. As such, SDD as standard OAB in elective colorectal surgery is highly recommended.
口服抗生素（OAB）在结直肠手术中已被证明可降低手术部位感染（SSI）和吻合口漏的发生率。然而，关于长期随访、再干预率和 5 年肿瘤学随访的证据尚缺乏。本研究旨在阐明这一知识空白。
本研究评估了围手术期“选择性消化道去污”（SDD）在结直肠癌手术中的长期疗效。主要结局为 90 天内吻合口漏，次要结局包括感染性并发症、再干预、再入院、住院时间以及 5 年总生存率和无病生存率。采用单因素和多因素分析来确定 90 天结局的预测因素，并采用 Kaplan-Meier 生存分析来评估 5 年生存结局。
共分析了 455 例患者，SDD 组 228 例，对照组 227 例。SDD 组和对照组的吻合口漏发生率无统计学差异（6.6%比 9.7%）。SDD 组有 15.4%的患者发生 1 种或多种感染性并发症，对照组为 28.2%（OR 0.46，95%CI 0.29-0.73）。SDD 组 8.8%的患者需要再次干预，对照组为 16.3%（OR 0.47，95%CI 0.26-0.84）。多因素分析后，SDD 在减少 90 天随访时的感染性并发症和再次干预方面仍然具有显著意义。SDD 组和对照组在 5 年总生存率和无病生存率方面无差异。
作为 OAB 的 SDD 可有效降低 90 天术后感染性并发症和再干预的发生率。因此，建议将 SDD 作为择期结直肠手术的标准 OAB。
