Effectiveness of leukocytapheresis in suppressing the occurrence of surgical site infections following surgery for ulcerative colitis.
OBJECTIVE
Surgical site infections (SSIs) occur more frequently in surgery for patients with ulcerative colitis than in regular colon surgery. We report here on a joint study that was prospectively conducted by six facilities to verify that performing leukocytapheresis (LCAP) therapy immediately following surgery regulates neutrophil activity and acts to suppress the occurrence of SSIs.


METHODS
LCAP was performed using Cellsorba EX with nafamostat mesilate as an anticoagulant; therapy was begun within 2 h postoperatively. Subjects were 143 patients undergoing surgery in cases of ulcerative colitis (LCAP group, 40 patients; control group, 103 patients).


RESULTS
1) With regard to the SSI incidence rate, SSIs occurred in 4 of 37 patients (10.8%) in the LCAP group overall, whereas they occurred in 29 of 103 patients (28.2%) in the control group overall; in the LCAP group, the occurrence of SSIs tended to be suppressed (P = 0.069). With 2-stage surgery in particular, SSIs occurred in the LCAP group in 1 of 28 patients (3.6%) and in the control group in 21 of 86 patients (24.4%); in the LCAP group, the occurrence of SSIs was significantly lower (P = 0.013). The length of postoperative hospitalization was 24.9 +/- 11.1 days for the 36 patients in the LCAP group and 31.2 +/- 14.6 days for the 103 patients in the control group; the length was significantly reduced in the LCAP group (P = 0.018). 2) From pre-surgery to day 1 of hospitalization, the granulocyte elastase level rose both in patients who experienced SSIs and in patients who did not experience them. It remained high in patients who experienced SSIs in comparison with patients who did not experience SSIs and was significantly higher prior to LCAP in particular. 3) While LCAP was being performed, there were adverse events in 5 of 40 patients (12.5%), but these were all transient; it was determined that LCAP presented no problems in terms of safety.


CONCLUSIONS
LCAP therapy was effective in suppressing the occurrence of SSIs following 2-stage surgery for ulcerative colitis and also reduced the length of postoperative hospitalization.
Itabashi
Michio
M
Department of Surgery 2, Tokyo Women's Medical University, Tokyo, Japan.
Ikeuchi
Hiroki
H
Araki
Toshimitsu
T
Kono
Toru
T
Nakamura
Toshio
T
Takesue
Yoshio
Y
Kameoka
Shingo
S
Kusunoki
Masato
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000032:analysis; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan; D007902:Length of Stay; D007937:Leukapheresis / Q000379:methods*; D019272:Leukocyte Elastase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D002097:C-Reactive Protein; D019272:Leukocyte Elastase