Ong Wee Liam, Morarasu Stefan, Lunca Sorinel, Pruna Romulus Mihaita, Roata Cristian Ene, Dimofte Gabriel Mihail
2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania.
Department of Surgery, Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania.
J Surg Oncol. 2025 Mar;131(3):489-497. doi: 10.1002/jso.27923. Epub 2024 Sep 30.
There is limited research available concerning the risk anastomotic leakage in the context of Clostridium difficile infection (CDI). Herein, we aim to elucidate the correlation between CDI, encompassing both preoperative asymptomatic C. difficile carriers (CDC) and postoperative hospital acquired C. difficile infections (HA-CDI), and the occurrence of anastomotic leakage in patients undergoing oncological colorectal surgery.
This is an observational, single-center study. Data were sourced from surgical logs between 2018 and 2023, via the hospital's electronic system. Patients were split into three subgroups: CDC, HA-CDI, and control group (CG). Groups were compared in terms of patient characteristics, morbidity, and mortality via Fisher's exact test and Kruskal-Wallis test. One-to-one propensity score matching was performed to reduce selection bias.
A total of 522 patients were analyzed, split into three subgroups: CDC, n = 35; HA-CDI, n = 27; CG, n = 460. One-to-one propensity score matching reduced the CG to 62 patients. Patients in the HA-CDI group had higher rates of overall morbidity (p < 0.0001), higher rates of anastomotic leaks (p = 0.002), more surgical site infections (SSI) (p = 0.001), and a longer length of stay (26 vs. 11.2 vs. 9.3 days, p < 0.001), while patients in the CDC group had comparable rates of complications with the CG.
HA-CDI is associated with a higher risk of anastomotic leak after oncological colorectal surgery, while asymptomatic CDC do not have higher morbidity and may be operated electively, under standard CD treatment.
关于艰难梭菌感染（CDI）情况下吻合口漏风险的研究有限。在此，我们旨在阐明CDI（包括术前无症状艰难梭菌携带者（CDC）和术后医院获得性艰难梭菌感染（HA-CDI））与接受肿瘤性结直肠手术患者吻合口漏发生之间的相关性。
这是一项单中心观察性研究。数据通过医院电子系统从2018年至2023年的手术记录中获取。患者分为三个亚组：CDC组、HA-CDI组和对照组（CG）。通过Fisher精确检验和Kruskal-Wallis检验对各组患者的特征、发病率和死亡率进行比较。进行一对一倾向评分匹配以减少选择偏倚。
共分析了522例患者，分为三个亚组：CDC组，n = 35；HA-CDI组，n = 27；CG组，n = 460。一对一倾向评分匹配后，CG组减少至62例患者。HA-CDI组患者的总体发病率较高（p < 0.0001），吻合口漏发生率较高（p = 0.002），手术部位感染（SSI）更多（p = 0.001），住院时间更长（26天对11.2天对9.3天，p < 0.001），而CDC组患者的并发症发生率与CG组相当。
HA-CDI与肿瘤性结直肠手术后吻合口漏的较高风险相关，而无症状的CDC发病率并不更高，在标准CD治疗下可择期手术。
