title: Malignancy is a risk factor for postoperative infectious complications after elective colorectal resection.
abstract: OBJECTIVE
  Patient and technical factors influencing the postoperative infectious complications (ICs) after elective colorectal resections are satisfactorily described. However, the underlying disease-related factors have not been extensively evaluated. This study aimed to measure the effect of malignancy on postoperative surgical site and extra surgical site infections after elective colorectal resection.
  
  
  METHODS
  This study is a bicentric retrospective matched pair study of prospectively gathered data. Between 2004 and 2013, 1104 consecutive patients underwent colorectal resection in two centers. Patients undergoing elective resection with supraperitoneal anastomosis for benign diseases (excluding inflammatory bowel disease) (group B, n = 305) were matched to randomly selected patients with malignancy (group M, n = 305). The matching variables were age, gender, American Society of Anesthesiologists (ASA) score, malnutrition, type of resection, and surgical approach. We compared the 30-day IC rates between patients with benign diseases (group B) and malignancy (group M). Multivariate logistic regression analysis was performed to identify the risk factors for ICs.
  
  
  RESULTS
  Group M had a higher overall rate of IC (25.6 vs 16.1 %, P = 0.004) as well as a higher risk of extra surgical site infections (P = 0.007) and anastomotic leakage (P = 0.039). The independent risk factors for ICs were malignancy (odds ratio (OR) = 2.02; P = 0.002), age ≥70 years (OR = 1.73, P = 0.018), tobacco history (OR = 1.87; P = 0.030), and obesity (OR = 1.68; P = 0.039).
  
  
  CONCLUSIONS
  Malignancy, age, tobacco history, and obesity increase the risk of ICs after colorectal resection. Improvement of the modifiable risk factors, increased compliance with an enhanced recovery after surgery (ERAS) program in the overall population, and optimization of immune function in patients with malignancy should be considered.
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France.|University of Lille Nord de France, Lille, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Crombe
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France.|University of Lille Nord de France, Lille, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Bot
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France.|University of Lille Nord de France, Lille, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Messager
authors.affiliation: Mathilde Clinic, Rouen, France.
authors.forename: Vianney
authors.initials: V
authors.lastname: Roger
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France.|University of Lille Nord de France, Lille, France.|Inserm UMR-S 1172, Jean Pierre Aubert Research Center, Team 5 "Mucins, epithelial differentiation and carcinogenesis, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Régional Universitaire, Place de Verdun, 59037, Lille cedex, France. guillaume.piessen@chru-lille.fr.|University of Lille Nord de France, Lille, France. guillaume.piessen@chru-lille.fr.|Inserm UMR-S 1172, Jean Pierre Aubert Research Center, Team 5 "Mucins, epithelial differentiation and carcinogenesis, Lille, France. guillaume.piessen@chru-lille.fr.
authors.forename: Guillaume
authors.identifier: http://orcid.org/0000-0001-8243-8310
authors.initials: G
authors.lastname: Piessen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology*; D055815:Young Adult
keywords: Cancer; Colorectal resection; Infectious complications; Laparoscopy; Morbidity; Nutrition
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