Differences in surgical site infection between laparoscopic colon and rectal surgeries: sub-analysis of a multicenter randomized controlled trial (Japan-Multinational Trial Organization PREV 07-01).
BACKGROUND
The incidence of surgical site infection (SSI) is reportedly lower in laparoscopic colorectal surgery than in open surgery, but data on the difference in SSI incidence between colon and rectal laparoscopic surgeries are limited.


METHODS
The incidence and risk factors for SSI, and the effect of oral antibiotics in colon and rectal laparoscopic surgeries, were investigated as a sub-analysis of the JMTO-PREV-07-01 (a multicenter, randomized, controlled trial of oral/parenteral vs. parenteral antibiotic prophylaxis in elective laparoscopic colorectal surgery).


RESULTS
A total of 582 elective laparoscopic colorectal resections, comprising 376 colon surgeries and 206 rectal surgeries, were registered. The incidence of SSI in rectal surgery was significantly higher than in colon surgery (14 vs. 8.2 %, P = 0.041). Although the incidence of incisional SSI was almost identical (7 %) between the surgeries, the incidence of organ/space SSI in rectal surgery was significantly higher than in colon surgery (6.3 vs. 1.1 %, P = 0.0006). The lack of oral antibiotics was significantly associated with the development of SSI in colon surgery. Male sex, stage IV cancer, and abdominoperineal resection were significantly associated with SSI in rectal surgery. The combination of oral and parenteral antibiotics significantly reduced the overall incidence of SSI in colon surgery (relative risk 0.41, 95 % confidence interval 0.19-0.86).


CONCLUSIONS
The incidence of SSI in laparoscopic rectal surgery was higher than in colon surgery because of the higher incidence of organ/space SSI in rectal surgery. The risk factors for SSIs and the effect of oral antibiotics differed between these two procedures.
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. saori2@kuhp.kyoto-u.ac.jp.
Saori
S
Goto
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Suguru
S
Hasegawa
Department of Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
Hiroaki
H
Hata
Department of Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan.
Takashi
T
Yamaguchi
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Koya
K
Hida
Department of Surgery, Digestive Disease Center, Kyoto Katsura Hospital, Kyoto, Japan.
Ryuta
R
Nishitai
Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan.
Satoshi
S
Yamanokuchi
Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan.
Akinari
A
Nomura
Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan.
Takeharu
T
Yamanaka
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Yoshiharu
Y
Sakai
D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000209:etiology*
D000900:Anti-Bacterial Agents
Antibiotic prophylaxis; Colorectal surgery; Laparoscopic surgery; Oral antibiotics; Surgical site infection; Wound infection