Management and outcomes of anorectal infection in the cancer patient.
BACKGROUND
The objective of this retrospective cohort study is to examine the presentation and outcomes for a contemporary series of cancer patients with anorectal infection. In addition, we seek to identify factors which are associated with surgical intervention.


METHODS
The study cohort was identified from International Classification of Disease (ICD)-9 codes for diagnosis of infection of the anal and rectal region and patients who underwent a surgical oncology consultation at The University of Texas M.D. Anderson Cancer Center between 1/2000 and 12/2006. Clinical presentation, treatment rendered, and outcomes were retrospectively recorded.


RESULTS
Of the 100 patients evaluated by the surgical oncology service for anorectal infection, 42 were treated nonoperatively and 58 underwent surgical intervention. Factors associated with surgical intervention based on logistic multivariable analysis included diagnosis of an abscess [odds ratio (OR) 10.5, 95% confidence interval (CI) 2.9-38.5] and documentation of erythema on physical examination (OR 3.1, 95% CI 1.1-8.4). Thrombocytopenia (platelets <50,000) was associated with nonoperative management (OR 0.3, 95% CI 0.1-0.7). Incision and drainage was the most common surgical procedure (79%) while a wide debridement for a necrotizing soft tissue infection was required in two patients. Infection-specific 90-day mortality was 1% (n = 1), attributable to a necrotizing infection. However, median overall survival for the entire cohort was only 14.4 months (95% CI 7.9-19.5 months).


CONCLUSIONS
Identification of an abscess, erythema on physical exam, and thrombocytopenia were associated with management strategy. Although rare, necrotizing soft tissue infections are associated with significant mortality.
Badgwell
Brian D
BD
Department of Surgical Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA. badgwell@uams.edu
Chang
George J
GJ
Rodriguez-Bigas
Miguel A
MA
Smith
Kerrington
K
Lupo
Philip J
PJ
Frankowski
Ralph F
RF
Delclos
George
G
Du
Xianglin L
XL
Cormier
Janice
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001004:Anus Diseases / Q000382:microbiology / Q000628:therapy*; D001424:Bacterial Infections / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications / Q000382:microbiology*; D011379:Prognosis; D012002:Rectal Diseases / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000890:Anti-Infective Agents