title: Deep Pelvic Surgical Site Infection After Radiotherapy and Surgery for Locally Advanced Rectal Cancer.
abstract: BACKGROUND
  High morbidity, increased mortality, and impaired long-term oncologic outcome have been reported after deep surgical site infection (SSI) in rectal cancer surgery. The rate, risk factors and consequences of deep SSI after (chemo)radiotherapy [(C)RT], and surgery for locally advanced rectal cancer (LARC) in a tertiary university hospital single centre cohort of 540 patients are presented.
  
  
  METHODS
  Patients with LARC, operated between January 1, 2007 and December 31, 2015, were identified in the institutional prospective database. All patients had tumours threatening the mesorectal fascia or invading adjacent organs, with a high rate of T4 tumours (60 %), and all received (C)RT. Risk factors for deep SSI were calculated by multivariable logistic regression analysis. Morbidity data were assessed. Overall survival (OS) and disease-free survival (DFS) between patients with or without deep SSI were estimated.
  
  
  RESULTS
  Of 540 patients, 104 (19 %) experienced a deep SSI, with the highest rate in the abdominoperineal resection (APR) group with 25 %. APR, good response to (C)RT (low tumour regression grade), age, and operative blood loss were identified as significant (P < 0.05) risk factors for deep SSI in multivariable analysis. No difference was found in OS (P = 0.995) or DFS (P = 0.568). Hospital stay increased with 5 days (P < 0.001), and complete wound healing at the 3-month follow-up decreased from 86 to 45 % (P < 0.001) after deep SSI.
  
  
  CONCLUSIONS
  Deep SSI is a frequent and major complication after rectal surgery for LARC, with high morbidity, increased hospital stay and protracted wound healing. Interestingly, deep SSI did not influence long-term oncologic outcome.
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway. ebbtho@rr-research.no.|Institute of Immunology, Oslo University Hospital Rikshospitalet and University of Oslo, Oslo, Norway. ebbtho@rr-research.no.
authors.forename: E B
authors.initials: EB
authors.lastname: Thorgersen
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.
authors.forename: M A
authors.initials: MA
authors.lastname: Goscinski
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Spasojevic
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.
authors.forename: A M
authors.initials: AM
authors.lastname: Solbakken
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.
authors.forename: A B
authors.initials: AB
authors.lastname: Mariathasan
authors.affiliation: Department of Oncology, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.|Department of Tumour Biology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Boye
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.
authors.forename: S G
authors.initials: SG
authors.lastname: Larsen
authors.affiliation: Department of Gastroenterological Surgery, The Norwegian Radium Hospital Oslo University Hospital, Oslo, Norway.|Department of Tumour Biology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Flatmark
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D059248:Chemoradiotherapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology* / Q000382:microbiology; D015996:Survival Rate; D014945:Wound Healing