Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Stefan Buettner, Cecilia G. Ethun, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Matthew J Weiss, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C.G. Martin, Charles R. Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras, Rivfka Shenoy, Bas Groot Koerkamp & 2 others Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). Methods: Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results: Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p = 0.008). Conclusion: SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Gastrointestinal Surgery
DOIs
StateAccepted/In press - Sep 14 2017

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Surgical Wound Infection
Recurrence
Neoplasms
Survival
Klatskin Tumor
Gallbladder Neoplasms
Pancreaticoduodenectomy
Cholangiocarcinoma
Proportional Hazards Models
Abscess

Keywords

  • Cholangiocarcinoma
  • Gallbladder cancer
  • Recurrence free survival
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Buettner, S., Ethun, C. G., Poultsides, G., Tran, T., Idrees, K., Isom, C. A., ... Pawlik, T. M. (Accepted/In press). Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. Journal of Gastrointestinal Surgery, 1-8. https://doi.org/10.1007/s11605-017-3571-2

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. / Buettner, Stefan; Ethun, Cecilia G.; Poultsides, George; Tran, Thuy; Idrees, Kamran; Isom, Chelsea A.; Weiss, Matthew J; Fields, Ryan C.; Krasnick, Bradley; Weber, Sharon M.; Salem, Ahmed; Martin, Robert C.G.; Scoggins, Charles R.; Shen, Perry; Mogal, Harveshp D.; Schmidt, Carl; Beal, Eliza; Hatzaras, Ioannis; Shenoy, Rivfka; Koerkamp, Bas Groot; Maithel, Shishir K.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, 14.09.2017, p. 1-8.

Research output: Contribution to journalArticle

Buettner, S, Ethun, CG, Poultsides, G, Tran, T, Idrees, K, Isom, CA, Weiss, MJ, Fields, RC, Krasnick, B, Weber, SM, Salem, A, Martin, RCG, Scoggins, CR, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Shenoy, R, Koerkamp, BG, Maithel, SK & Pawlik, TM 2017, 'Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies', Journal of Gastrointestinal Surgery, pp. 1-8. https://doi.org/10.1007/s11605-017-3571-2
Buettner, Stefan ; Ethun, Cecilia G. ; Poultsides, George ; Tran, Thuy ; Idrees, Kamran ; Isom, Chelsea A. ; Weiss, Matthew J ; Fields, Ryan C. ; Krasnick, Bradley ; Weber, Sharon M. ; Salem, Ahmed ; Martin, Robert C.G. ; Scoggins, Charles R. ; Shen, Perry ; Mogal, Harveshp D. ; Schmidt, Carl ; Beal, Eliza ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Koerkamp, Bas Groot ; Maithel, Shishir K. ; Pawlik, Timothy M. / Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. In: Journal of Gastrointestinal Surgery. 2017 ; pp. 1-8.
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abstract = "Background: Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). Methods: Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results: Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4{\%}) patients had perihilar cholangiocarcinoma, 241 (33.1{\%}) gallbladder cancer, and 251 (34.5{\%}) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3{\%}) patients, while 110 (15.2{\%}) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8{\%}; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6{\%}) or formation of an abscess in the operative bed (n = 91, 12.5{\%}). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95{\%} CI 1.08–1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95{\%} CI 1.03–3.29; p = 0.038), as well as overall survival (HR 1.87, 95{\%} CI 1.18–2.97; p = 0.008). Conclusion: SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.",
keywords = "Cholangiocarcinoma, Gallbladder cancer, Recurrence free survival, Surgical site infection",
author = "Stefan Buettner and Ethun, {Cecilia G.} and George Poultsides and Thuy Tran and Kamran Idrees and Isom, {Chelsea A.} and Weiss, {Matthew J} and Fields, {Ryan C.} and Bradley Krasnick and Weber, {Sharon M.} and Ahmed Salem and Martin, {Robert C.G.} and Scoggins, {Charles R.} and Perry Shen and Mogal, {Harveshp D.} and Carl Schmidt and Eliza Beal and Ioannis Hatzaras and Rivfka Shenoy and Koerkamp, {Bas Groot} and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
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T1 - Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

AU - Buettner, Stefan

AU - Ethun, Cecilia G.

AU - Poultsides, George

AU - Tran, Thuy

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Weiss, Matthew J

AU - Fields, Ryan C.

AU - Krasnick, Bradley

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C.G.

AU - Scoggins, Charles R.

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Koerkamp, Bas Groot

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2017/9/14

Y1 - 2017/9/14

N2 - Background: Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). Methods: Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results: Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p = 0.008). Conclusion: SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.

AB - Background: Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). Methods: Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results: Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p = 0.008). Conclusion: SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.

KW - Cholangiocarcinoma

KW - Gallbladder cancer

KW - Recurrence free survival

KW - Surgical site infection

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