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Infectious Complications in Laparoscopic Gynecologic Oncology Surgery within an ERAS-Compliant Setting
Vito Andrea Capozzi1, Alessandra De Finis1, Elisa Scarpelli1
1Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy.
Abstract:
Minimally Invasive Surgery (MIS) represents a safe and feasible option for the surgical treatment of gynecologic malignancies, offering benefits, including reduced blood loss, lower complications, and faster recovery, without compromising oncological outcomes in selected patients. MIS is widely accepted in early-stage gynecologic malignancies, including endometrial cancer, cervical tumors measuring 2 cm or less, and early-stage ovarian cancer, considering the risk of surgical spillage. Despite its advantages, MIS does not rule out the possibility of adverse events such as postoperative infections. This retrospective study on 260 patients undergoing laparoscopic surgery at Parma University Hospital for gynecologic malignancies explores the incidence and risk factors of postoperative infectious complications. The Clavien-Dindo classification was used to rank postoperative surgical complications occurring 30 days after surgery and Enhanced Recovery After Surgery (ERAS) recommendations put into practice. In our population, 15 (5.8%) patients developed infectious complications, predominantly urinary tract infections (9, 3.5%). Longer surgical procedures were independently associated with higher postoperative infection risk (p = 0.045). Furthermore, C1 radical hysterectomy correlated significantly with infectious complications (p = 0.001, OR 3.977, 95% CI 1.370-11.544). In conclusion, compared to prior research, our study reported a lower rate of infectious complications occurrence and highlights the importance of adopting infection prevention measures.
Insights
Minimally invasive surgery (MIS) for gynecologic cancers is safe and effective. This study found a low rate of postoperative infections, with longer surgeries and radical hysterectomy being risk factors.
Area of Science:
- Gynecology
- Surgical Oncology
- Infectious Diseases
Background:
- Minimally invasive surgery (MIS) offers benefits for gynecologic cancer treatment, including reduced complications and faster recovery.
- Despite advantages, postoperative infections remain a potential adverse event in MIS for gynecologic malignancies.
- Enhanced Recovery After Surgery (ERAS) protocols are increasingly implemented to optimize patient outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors of postoperative infectious complications following laparoscopic surgery for gynecologic malignancies.
- To evaluate the association between surgical factors and the occurrence of infections.
- To compare infection rates with existing literature and emphasize preventive strategies.
Main Methods:
- Retrospective analysis of 260 patients undergoing laparoscopic surgery for gynecologic malignancies at Parma University Hospital.
- Infection complications were identified and ranked using the Clavien-Dindo classification within 30 days post-surgery.
- Data analysis focused on identifying independent risk factors for infectious complications, including surgical duration and procedure type.
Main Results:
- A total of 15 patients (5.8%) experienced infectious complications, with urinary tract infections being the most common (3.5%).
- Longer surgical duration was independently associated with an increased risk of postoperative infections (p=0.045).
- C1 radical hysterectomy showed a significant correlation with infectious complications (p=0.001, OR 3.977).
Conclusions:
- This study reports a lower incidence of infectious complications in MIS for gynecologic cancer compared to previous research.
- Extended surgical times and specific procedures like C1 radical hysterectomy are significant risk factors for postoperative infections.
- Adherence to infection prevention measures is crucial for minimizing adverse events in gynecologic MIS.
