TY - JOUR
T1 - Survival impact of surgical site infection in esophageal cancer surgery
T2 - A multicenter retrospective cohort study
AU - Matsuda, Akihisa
AU - Maruyama, Hiroshi
AU - Akagi, Shinji
AU - Inoue, Toru
AU - Uemura, Kenichiro
AU - Kobayashi, Minako
AU - Shiomi, Hisanori
AU - Watanabe, Manabu
AU - Fujita, Takeo
AU - Takahata, Risa
AU - Takeda, Shigeru
AU - Fukui, Yasuo
AU - Toiyama, Yuji
AU - Hagiwara, Nobutoshi
AU - Kaito, Akio
AU - Matsutani, Takeshi
AU - Yasuda, Tomohiko
AU - Yoshida, Hiroshi
AU - Tsujimoto, Hironori
AU - Kitagawa, Yuko
N1 - Funding Information:
The authors extend their deep appreciation to Prof. Shinya Kusachi, immediate past president of the Japan Society for Surgical Infection, and Prof. Kazuo Tanemoto, director of the Clinical Trial Committee of the Japan Society for Surgical Infection, for their considerable cooperation. The authors also thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac), for editing a draft of this article.
Publisher Copyright:
© 2022 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.
PY - 2023/7
Y1 - 2023/7
N2 - Aim: This study was performed to evaluate the oncological impact of surgical site infection (SSI) and pneumonia on long-term outcomes after esophagectomy. Methods: The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 407 patients with curative stage I/II/III esophageal cancer at 11 centers from April 2013 to March 2015. We investigated the association of SSI and postoperative pneumonia with oncological outcomes in terms of relapse-free survival (RFS) and overall survival (OS). Results: Ninety (22.1%), 65 (16.0%), and 22 (5.4%) patients had SSI, pneumonia, and both SSI and pneumonia, respectively. The univariate analysis demonstrated that SSI and pneumonia were associated with worse RFS and OS. In the multivariate analysis, however, only SSI had a significant negative impact on RFS (HR, 1.63; 95% confidence interval, 1.12–2.36; P = 0.010) and OS (HR, 2.06; 95% confidence interval, 1.41–3.01; P < 0.001). The presence of both SSI and pneumonia and the presence of severe SSI had profound negative oncological impacts. Diabetes mellitus and an American Society of Anesthesiologists score of III were independent predictive factors for both SSI and pneumonia. The subgroup analysis showed that three-field lymph node dissection and neoadjuvant therapy canceled out the negative oncological impact of SSI on RFS. Conclusion: Our study demonstrated that SSI, rather than pneumonia, after esophagectomy was associated with impaired oncological outcomes. Further progress in the development of strategies for SSI prevention may improve the quality of care and oncological outcomes in patients undergoing curative esophagectomy.
AB - Aim: This study was performed to evaluate the oncological impact of surgical site infection (SSI) and pneumonia on long-term outcomes after esophagectomy. Methods: The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 407 patients with curative stage I/II/III esophageal cancer at 11 centers from April 2013 to March 2015. We investigated the association of SSI and postoperative pneumonia with oncological outcomes in terms of relapse-free survival (RFS) and overall survival (OS). Results: Ninety (22.1%), 65 (16.0%), and 22 (5.4%) patients had SSI, pneumonia, and both SSI and pneumonia, respectively. The univariate analysis demonstrated that SSI and pneumonia were associated with worse RFS and OS. In the multivariate analysis, however, only SSI had a significant negative impact on RFS (HR, 1.63; 95% confidence interval, 1.12–2.36; P = 0.010) and OS (HR, 2.06; 95% confidence interval, 1.41–3.01; P < 0.001). The presence of both SSI and pneumonia and the presence of severe SSI had profound negative oncological impacts. Diabetes mellitus and an American Society of Anesthesiologists score of III were independent predictive factors for both SSI and pneumonia. The subgroup analysis showed that three-field lymph node dissection and neoadjuvant therapy canceled out the negative oncological impact of SSI on RFS. Conclusion: Our study demonstrated that SSI, rather than pneumonia, after esophagectomy was associated with impaired oncological outcomes. Further progress in the development of strategies for SSI prevention may improve the quality of care and oncological outcomes in patients undergoing curative esophagectomy.
KW - esophageal cancer
KW - pneumonia
KW - surgical site infection
KW - survival
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U2 - 10.1002/ags3.12656
DO - 10.1002/ags3.12656
M3 - Article
AN - SCOPUS:85146924450
SN - 2475-0328
VL - 7
SP - 603
EP - 614
JO - Annals of Gastroenterological Surgery
JF - Annals of Gastroenterological Surgery
IS - 4
ER -
