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Original Research

Open Access

Surgical site infection after cytoreductive surgery in patients with ovarian, fallopian tube and primary peritoneal cancer, is an independent predictor of poor overall survival via significant delays in adjuvant chemotherapy

  • Yeo-Jin Lee1
  • Eun-Ju Lee1,2,*,

1Department of Obstetrics and Gynecology, Chung-Ang University College of Medicine Chung-Ang University Hospital, 06973 Seoul, Republic of Korea

2Department of Microbiology and Molecular Genetics, University of California, Irvine, CA 92697, USA

DOI: 10.22514/ejgo.2023.095 Vol.44,Issue 6,December 2023 pp.20-28

Submitted: 25 February 2023 Accepted: 24 May 2023

Published: 15 December 2023

*Corresponding Author(s): Eun-Ju Lee E-mail: ejlee@cau.ac.kr

Abstract

Surgical site infection (SSI) is associated with substantial morbidity. However, the incidence and clinical significance of SSIs after cytoreductive surgery in Korean females with epithelial ovarian, fallopian tube and peritoneal cancer (EOFPC) are unknown. We aimed to assess the incidence and consequences of SSI within 30 days after cytoreductive surgery in patients with EOFPC. After estimating the effect size, SSIs were retrospectively investigated in 149 patients between 2011 and 2020. Survival and multivariate analyses were performed using Kaplan-Meier estimates and the Cox regression method that included the interaction terms, respectively. Clinical factors for patients with or without SSI were compared using the Mann-Whitney U test and Fisher’s exact test. The overall rate of SSI was 9.4% (14 of 149 patients), consisting of five superficial, three deep and six organ/space SSIs. No clinical significance of SSI was observed when analyzing the 149 cases. Among the 91 patients with FIGO stage III–IV serous type carcinomas, eight experienced SSI, and their clinical factors were compared with those of the 83 patients without SSI. A univariate analysis showed that patient age, neoadjuvant chemotherapy, suboptimal debulking status, FIGO stage, chemoresistance, a longer interval from surgery to initiation of chemotherapy (ISIC), and SSI occurrence were significantly associated with overall survival. The multivariate analysis showed that higher FIGO stage (HR 21.138; 95% CI 2.796–159.819; p = 0.003) and SSI occurrence (HR 21.999; 95% CI 2.616–184.986; p = 0.004) were independent predictors for poor overall survival. The SSI group had a significantly greater body mass index (p = 0.006) and a longer ISIC (23 ± 9.1 vs. 40.0 ± 25.7 days; p = 0.006) compared with the non-SSI group. In conclusion, SSI after cytoreductive surgery in patients with FIGO stage III–IV serous type carcinoma significantly worsened patient prognosis and delayed initiation of adjuvant chemotherapy.


Keywords

Cytoreductive surgery; Ovarian cancer; Overall Survival; Surgical site infection


Cite and Share

Yeo-Jin Lee,Eun-Ju Lee. Surgical site infection after cytoreductive surgery in patients with ovarian, fallopian tube and primary peritoneal cancer, is an independent predictor of poor overall survival via significant delays in adjuvant chemotherapy. European Journal of Gynaecological Oncology. 2023. 44(6);20-28.

References

[1] Ha HI, Chang HK, Park SJ, Lim J, Won Y, Lim MC. The incidence and survival of cervical, ovarian, and endometrial cancer in Korea, 1999–2017: Korea central cancer registry. Obstetrics & Gynecology Science. 2021; 64: 444–453.

[2] Kurnit KC, Fleming GF, Lengyel E. Updates and new options in advanced epithelial ovarian cancer treatment. Obstetrics & Gynecology. 2021; 137: 108–121.

[3] Covens AL. A critique of surgical cytoreduction in advanced ovarian cancer. Gynecologic Oncology. 2000; 78: 269–274.

[4] Berrios-Torres, SI, Umscheid, CA, Bratzler, D, Leas B, Stone EC, Kelz RR, et al. Centers for disease control and prevention guideline for prevention of surgical site infection, 2017. JAMA Surgery. 2017; 152: 784–791.

[5] Seidelman J, Anderson DJ. Surgical site infections. Infectious Disease Clinics of North America. 2021; 35: 901–929.

[6] Johnson MP, Kim SJ, Langstraat CL, Jain S, Habermann EB, Wentink JE, et al. Using bundled interventions to reduce surgical site infection after major gynecologic cancer surgery. Obstetrics & Gynecology. 2016; 127: 1135–1144.

[7] Lippitt MH, Fairbairn MG, Matsuno R, Stone RL, Tanner EJ, Wick EC, et al. Outcomes associated with a five-point surgical site infection prevention bundle in women undergoing surgery for ovarian cancer. Obstetrics & Gynecology. 2017; 130: 756–764.

[8] Mahdi H, Gojayev A, Buechel M, Knight J, SanMarco J, Lockhart D, et al. Surgical site infection in women undergoing surgery for gynecologic cancer. International Journal of Gynecologic Cancer. 2014; 24: 779–786.

[9] O’Donnell RL, Angelopoulos G, Beirne JP, Biliatis I, Bolton H, Bradbury M, et al. Impact of surgical site infection (SSI) following gynaecological cancer surgery in the UK: a trainee-led multicentre audit and service evaluation. BMJ Open. 2019; 9: e024853.

[10] Tran CW, McGree ME, Weaver AL, Martin JR, Lemens MA, Cliby WA, et al. Surgical site infection after primary surgery for epithelial ovarian cancer: predictors and impact on survival. Gynecologic Oncology. 2015; 136: 278–284.

[11] Bhalerao S, Kadam P. Sample size calculation. International Journal of Ayurveda Research. 2010; 1: 55–57.

[12] Di Donato V, Di Pinto A, Giannini A, Caruso G, D’Oria O, Tomao F, et al. Modified fragility index and surgical complexity score are able to predict postoperative morbidity and mortality after cytoreductive surgery for advanced ovarian cancer. Gynecologic Oncology. 2021; 161: 4–10.

[13] Calderwood MS, Anderson DJ, Bratzler DW, Dellinger EP, Garcia-Houchins S, Maragakis LL, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infection Control and Hospital Epidemiology. 2023; 44: 695–720.

[14] Matsuo K, Prather CP, Ahn EH, Eno ML, Tierney KE, Yessaian AA, et al. Significance of perioperative infection in survival of patients with ovarian cancer. International Journal of Gynecological Cancer. 2012; 22: 245–253.

[15] Cai B, Li K, Li G. Impact of obesity on major surgical outcomes in ovarian cancer: a meta-analysis. Frontier in Oncology. 2022; 12: 841306.

[16] Tewari KS, Java JJ, Eskander RN, Monk BJ, Burger RA. Early initiation of chemotherapy following complete resection of advanced ovarian cancer associated with improved survival: NRG Oncology/Gynecologic Oncology Group study. Annals of Oncology. 2016; 27: 114–121.

[17] Hofstetter G, Concin N, Braicu I, Chekerov R, Sehouli J, Cadron I, et al. The time interval from surgery to start of chemotherapy significantly impacts prognosis in patients with advanced serous ovarian carcinoma—analysis of patient data in the prospective OVCAD study. Gynecologic Oncology. 2013; 131: 15–20.

[18] Beyene RT, Derryberry SL, Barbul A. The effect of comorbidities on wound healing. The Surgical Clinics of North America. 2020; 100: 695–705.

[19] Katsumata K, Enomoto M, Ishizaki T, Fujita S, Kanemitsu Y, Ito M, et al. Risk factors for surgical site infection and association of surgical site infection with survival of lower rectal cancer patients without clinical lateral pelvic lymph node metastasis (clinical Stage II/III): analysis of data from JCOG0212. Clinical & Experimental Metastasis. 2021; 38: 459–466.

[20] Bernard L, Boucher J, Helpman L. Bowel resection or repair at the time of cytoreductive surgery for ovarian malignancy is associated with increased complication rate: an ACS-NSQIP study. Gynecologic Oncology. 2020; 158: 597–602.


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