Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
Anticancer Res. 2024 Aug;44(8):3473-3480. doi: 10.21873/anticanres.17167.
BACKGROUND/AIM: In colorectal cancer surgery, the risk of surgical site infection (SSI) is relatively high. The development of SSI is related to longer and costlier hospitalization and reduced quality of life; therefore, perioperative prevention of SSI is important. Chemical bowel preparation (CBP) combined with mechanical bowel preparation (MBP) may be more effective in preventing surgical site infection (SSI) compared to MBP alone. Since May 2021, we have been administering oral kanamycin and metronidazole as CBP, in addition to MBP, as a preoperative treatment for colorectal cancer surgery on the day before surgery. In this study, we investigated the clinical value of CBP in addition to MBP in colorectal cancer surgery using propensity score matching (PSM).
From January 2017 to December 2021, 136 consecutive patients underwent radical surgery for sigmoid colon and rectal cancer at the Osaka Metropolitan University Hospital. Patients were divided into two groups: CBP and N-CBP. In the N-CBP group, we performed only preoperative MBP, whereas in the CBP group, we performed preoperative CBP in addition to MBP. We retrospectively analyzed this relationship with PSM.
Overall, 46 patients underwent preoperative CBP and MBP, 90 patients underwent preoperative MBP only. PSM was performed between the CBP and N-CBP groups based on the following ten factors: age, sex, diabetes mellitus, preoperative therapy, Glasgow Prognostic Score (GPS), operative time, blood loss, stoma, and pathological stage. After PSM, univariate and multivariate analyses of the relationship between SSI and clinicopathological factors were performed. Univariate analysis showed that age and CBP were correlated with the rate of SSI (p=0.039 and p=0.017, respectively), whereas sex was relatively correlated with the rate of SSI (p=0.066). The multivariate analysis of significant factors identified age of 75 or more and non-CBP as an independent risk factor for incisional SSI (HR=9.5; p=0.049 and HR=5.4×e; p=0.020).
Preoperative CBP in addition to MBP was effective in preventing incisional SSI during colorectal cancer surgery.
背景/目的：在结直肠癌手术中，手术部位感染（SSI）的风险相对较高。SSI 的发展与住院时间延长和费用增加以及生活质量降低有关；因此，围手术期预防 SSI 非常重要。与单独使用机械肠道准备（MBP）相比，化学肠道准备（CBP）联合 MBP 可能更有效地预防手术部位感染（SSI）。自 2021 年 5 月以来，我们在手术前一天除了 MBP 之外，还使用口服卡那霉素和甲硝唑作为 CBP 对结直肠癌手术进行术前治疗。在这项研究中，我们使用倾向评分匹配（PSM）来研究 CBP 联合 MBP 在结直肠癌手术中的临床价值。
从 2017 年 1 月到 2021 年 12 月，共有 136 名连续患者在大阪市立大学医院接受了乙状结肠和直肠癌症根治性手术。患者分为两组：CBP 组和 N-CBP 组。在 N-CBP 组中，我们仅进行术前 MBP，而在 CBP 组中，我们在术前 CBP 联合 MBP。我们回顾性地分析了这种关系，并进行了 PSM。
总体而言，有 46 名患者接受了术前 CBP 和 MBP，90 名患者仅接受了术前 MBP。基于以下 10 个因素，在 CBP 和 N-CBP 组之间进行了 PSM：年龄、性别、糖尿病、术前治疗、格拉斯哥预后评分（GPS）、手术时间、出血量、造口和病理分期。进行 PSM 后，对 SSI 与临床病理因素之间的关系进行了单变量和多变量分析。单变量分析显示，年龄和 CBP 与 SSI 发生率相关（p=0.039 和 p=0.017），而性别与 SSI 发生率呈正相关（p=0.066）。对显著因素的多变量分析确定年龄为 75 岁或以上和非 CBP 为切口 SSI 的独立危险因素（HR=9.5；p=0.049 和 HR=5.4×e；p=0.020）。
在结直肠癌手术中，除了 MBP 之外，术前 CBP 可以有效预防切口 SSI。
