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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Oncology

Background:

  • Deep surgical site infection (SSI) is a known complication following rectal cancer surgery.
  • It is associated with increased morbidity, mortality, and poorer oncologic outcomes.
  • The specific impact of deep SSI after neoadjuvant chemoradiotherapy (CRT) and surgery for locally advanced rectal cancer (LARC) requires further investigation.

Purpose of the Study:

  • To determine the rate, risk factors, and consequences of deep SSI in patients undergoing surgery for LARC after (chemo)radiotherapy.
  • To assess the impact of deep SSI on short-term morbidity and long-term oncologic outcomes.

Main Methods:

  • A cohort of 540 patients with LARC who underwent surgery between 2007 and 2015 was analyzed.
  • Patients received neoadjuvant (chemo)radiotherapy, and all had tumors threatening the mesorectal fascia or invading adjacent organs.
  • Multivariable logistic regression identified risk factors for deep SSI, and oncologic outcomes (OS, DFS) were compared between patients with and without deep SSI.

Main Results:

  • Deep SSI occurred in 19% of patients, with the highest rate (25%) in the abdominoperineal resection (APR) group.
  • Risk factors included APR, good response to (C)RT, older age, and greater operative blood loss.
  • Deep SSI significantly increased hospital stay by 5 days and reduced complete wound healing at 3 months (86% vs. 45%).

Conclusions:

  • Deep SSI is a frequent complication after rectal surgery for LARC, leading to substantial morbidity and prolonged hospital stays.
  • Despite increased morbidity and delayed wound healing, deep SSI did not negatively influence overall survival or disease-free survival.
  • These findings highlight the importance of managing deep SSI to mitigate short-term complications without compromising long-term oncologic control.