Objective: To explore the incidence and risk factors of postoperative surgical site infection (SSI) after colon cancer surgery. Methods: A retrospective case-control study was performed. Patients diagnosed with colon cancer who underwent radical surgery between January 2016 and May 2021 were included, and demographic characteristics, comorbidities, laboratory tests, surgical data and postoperative complications were extracted from the specialized prospective database at Department of General Surgery, Peking Union Medical College Hospital. Case exclusion criteria: (1) simultaneously multiple primary colon cancer; (2) segmental resection, subtotal colectomy, or total colectomy; (3) patients undergoing colostomy/ileostomy during the operation or in the state of colostomy/ileostomy before the operation; (4) patients receiving natural orifice specimen extraction surgery or transvaginal colon surgery; (5) patients with the history of colectomy; (6) emergency operation due to intestinal obstruction, perforation and acute bleeding; (7) intestinal diversion operation; (8) benign lesions confirmed by postoperative pathology; (9) patients not following the colorectal clinical pathway of our department for intestinal preparation and antibiotic application. Univariate analysis and multivariate analysis were used to determine the risk factors of SSI after colon cancer surgery. Results: A total of 1291 patients were enrolled in the study. 94.3% (1217/1291) of cases received laparoscopic surgery. The incidence of overall SSI was 5.3% (69/1291). According to tumor location, the incidence of SSI in the right colon, transverse colon, left colon and sigmoid colon was 8.6% (40/465), 5.2% (11/213), 7.1% (7/98) and 2.1% (11/515) respectively. According to resection range, the incidence of SSI after right hemicolectomy, transverse colectomy, left hemicolectomy and sigmoid colectomy was 8.2% (48/588), 4.5% (2/44), 4.8% (8 /167) and 2.2% (11/492) respectively. Univariate analysis showed that preoperative BUN≥7.14 mmol/L, tumor site, resection range, intestinal anastomotic approach, postoperative diarrhea, anastomotic leakage, postoperative pneumonia, and anastomotic technique were related to SSI (all P<0.05). Multivariate analysis revealed that anastomotic leakage (OR=22.074, 95%CI: 6.172-78.953, P<0.001), pneumonia (OR=4.100, 95%CI: 1.546-10.869, P=0.005), intracorporeal anastomosis (OR=5.288, 95%CI: 2.919-9.577,P<0.001) were independent risk factors of SSI. Subgroup analysis showed that in right hemicolectomy, the incidence of SSI in intracorporeal anastomosis was 19.8% (32/162), which was significantly higher than that in extracorporeal anastomosis (3.8%, 16/426, χ(2)=40.064, P<0.001). In transverse colectomy [5.0% (2/40) vs. 0, χ(2)=0.210, P=1.000], left hemicolectomy [5.4% (8/148) vs. 0, χ(2)=1.079, P=0.599] and sigmoid colectomy [2.1% (10/482) vs. 10.0% (1/10), χ(2)=2.815, P=0.204], no significant differences of SSI incidence were found between intracorporeal anastomosis and extracorporeal anastomosis (all P>0.05). Conclusions: The incidence of SSI increases with the resection range from sigmoid colectomy to right hemicolectomy. Intracorporeal anastomosis and postoperative anastomotic leakage are independent risk factors of SSI. Attentions should be paid to the possibility of postoperative pneumonia and actively effective treatment measures should be carried out.
目的： 探讨结肠癌术后手术部位感染（SSI）发生率及其危险因素。 方法： 采用回顾性病例对照研究方法。检索北京协和医院基本外科结直肠专业组前瞻性登记的临床数据库，收集2016年1月至2021年5月期间，接受结肠癌手术的患者病例资料，包括患者基线资料、围手术期资料、术后并发症和随访资料。排除标准：（1）同时性多原发结肠癌；（2）接受分段切除、或结肠次全切除、或结肠全切除；（3）手术行一期肠造口术，或术前处于肠造口状态的患者；（4）经自然腔道标本取出手术或经阴道结肠手术；（5）患者有结肠切除手术史；（6）因肠梗阻、穿孔、急性出血等原因接受急诊手术；（7）行肠短路手术；（8）术后病理提示为良性病变；（9）未按照我科结直肠临床路径进行肠道准备和抗生素应用的患者。通过单因素分析和多因素分析探索结肠癌患者术后SSI的独立相关因素。 结果： 共1 291例患者被纳入研究，腹腔镜手术率为94.3%（1 217/1 291），总体手术部位感染的发生率为5.3%（69/1 291）。按照肿瘤部位划分，肿瘤位于右半结肠、横结肠、左半结肠和乙状结肠的SSI发生率分别为8.6%（40/465）、5.2%（11/213）、7.1%（7/98）和2.1%（11/515）。按照不同切除范围划分，右半结肠切除、横结肠切除、左半结肠切除和乙状结肠切除术后SSI发生率分别为8.2%（48/588）、4.5%（2/44）、4.8%（8/167）和2.2%（11/492）。单因素分析发现，术前血尿素氮≥7.14 mmol/L、肿瘤部位、手术切除范围、肠吻合途径、术后腹泻、术后吻合口漏及术后肺炎与SSI发生有关。多因素分析提示，吻合口漏（OR=22.074，95%CI：6.172~78.953，P<0.001）、术后肺炎（OR=4.100，95%CI：1.546~10.869，P=0.005）和全腔镜吻合（OR=5.288，95%CI：2.919~9.577，P<0.001）是术后SSI的独立危险因素。在亚组分析中发现，右半结肠切除的患者中，在全腔镜吻合下SSI发生率为19.8%（32/162），高于非全腔镜吻合的患者（3.8%，16/426），差异有统计学意义（χ(2)=40.064，P<0.001）。而在横结肠[5.0%（2/40）比0，χ(2)=0.210，P=1.000]、左半结肠[5.4%（8/148）比0，χ(2)=1.079，P=0.599]和乙状结肠切除[2.1%（10/482）比1/10，χ(2)=2.815，P=0.204]的患者中，全腔镜吻合与非全腔镜吻合术后SSI发生率差异均无统计学意义（均P>0.05）。 结论： 结肠切除术后SSI发生率随切除范围从乙状结肠至右半结肠呈现升高趋势；结肠手术中使用全腔镜吻合以及术后出现吻合口漏的患者，SSI的发生风险较高；出现SSI后，需警惕合并术后肺炎的可能并采取积极有效的干预措施。.
Keywords: Colon Cancer; Colon surgery; Retrospective study; Risk factor; Surgical site infection.