Antibiotic Bowel Decontamination in Gastrointestinal Surgery-A Single-Center 20 Years' Experience

Overview

Journal Front Surg

Specialty General Surgery

Date 2022 Jun 2

PMID 35651691

Authors

Josefine Schardey

Thomas von Ahnen

Emily Schardey

Alina Kappenberger

Petra Zimmermann

Florian Kuhn

Joachim Andrassy

Jens Werner

Helmut Arbogast

Ulrich Wirth

Affiliations

Soon will be listed here.

Abstract

Objective: Anastomotic leakage, surgical site infections, and other infectious complications are still common complications in gastrointestinal surgery. The concept of perioperative antibiotic bowel decontamination demonstrates beneficial effects in single randomized controlled trials (RCTs), but data from routine clinical use are still sparse. Our aim was to analyze the data from the routine clinical use of perioperative antibiotic bowel decontamination in gastrointestinal surgery.

Methods: Based on 20 years' experience, we performed a retrospective analysis of all cases in oncologic gastrointestinal surgery with the use of antibiotic bowel decontamination in gastric, sigmoid, and rectal cancer. Clinical data and perioperative outcomes were analyzed, especially regarding anastomotic leakage, surgical site infections, and other infectious complications.

Results: A total of = 477 cases of gastrointestinal surgery in gastric cancer ( = 80), sigmoid cancer ( = 168), and rectal cancer ( = 229) using a perioperative regimen of antibiotic bowel decontamination could be included in this analysis. Overall, anastomotic leakage occurred in 4.4% (2.5% gastric cancer, 3.0% sigmoid cancer, 6.1% rectal cancer) and surgical site infections in 9.6% (6.3% gastric cancer, 9.5% sigmoid cancer, 10.9% rectal cancer). The incidence of all infectious complications was 13.6% (12.5% gastric cancer, 11.3% sigmoid cancer, 15.7% rectal cancer). Mortality was low, with an overall rate of 1.1% (1.3% gastric cancer, 1.8% sigmoid cancer, 0.4% rectal cancer). Antibiotic decontamination was completed in 98.5%. No adverse effects of antibiotic bowel decontamination could be observed.

Conclusion: Overall, in this large cohort, we can report low rates of surgery-related serious morbidity and mortality when perioperative antibiotic bowel decontamination is performed. The rates are lower than other clinical reports. In our clinical experience, the use of perioperative antibiotic bowel decontamination appears to improve patient safety and surgical outcomes during gastrointestinal oncologic procedures in a routine clinical setting.

Citing Articles

Treatment and Prevention of Postoperative Leakage after Gastrectomy for Gastric Cancer.

Jeong S, Lee J, Seo K, Min J J Clin Med. 2023; 12(12).

PMID: 37373575 PMC: 10299500. DOI: 10.3390/jcm12123880.

References

Boccola M, Buettner P, Rozen W, Siu S, Stevenson A, Stitz R . Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg. 2010; 35(1):186-95. DOI: 10.1007/s00268-010-0831-7. View

Stoutenbeek C, Van Saene H, Miranda D, Zandstra D . The effect of selective decontamination of the digestive tract on colonisation and infection rate in multiple trauma patients. Intensive Care Med. 1984; 10(4):185-92. DOI: 10.1007/BF00259435. View

Lu Z, Rajendran N, Lynch A, Heriot A, Warrier S . Anastomotic Leaks After Restorative Resections for Rectal Cancer Compromise Cancer Outcomes and Survival. Dis Colon Rectum. 2016; 59(3):236-44. DOI: 10.1097/DCR.0000000000000554. View

Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P . Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011; 253(5):890-9. DOI: 10.1097/SLA.0b013e3182128929. View

Ravichandran D, Lamah M, Carty N, Johnson C . Extended lymph node dissection (D2 resection) should now be performed routinely in the curative surgical treatment of gastric carcinoma. Ann R Coll Surg Engl. 1995; 77(6):431-6. PMC: 2502460. View

Olivas A, Shogan B, Valuckaite V, Zaborin A, Belogortseva N, Musch M . Intestinal tissues induce an SNP mutation in Pseudomonas aeruginosa that enhances its virulence: possible role in anastomotic leak. PLoS One. 2012; 7(8):e44326. PMC: 3432121. DOI: 10.1371/journal.pone.0044326. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Andolfi C, Umanskiy K . Appraisal and Current Considerations of Robotics in Colon and Rectal Surgery. J Laparoendosc Adv Surg Tech A. 2018; 29(2):152-158. DOI: 10.1089/lap.2018.0571. View

Schardey H, Joosten U, Finke U, Staubach K, Schauer R, Heiss A . The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg. 1997; 225(2):172-80. PMC: 1190646. DOI: 10.1097/00000658-199702000-00005. View

10.

Rahbari N, Weitz J, Hohenberger W, Heald R, Moran B, Ulrich A . Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2009; 147(3):339-51. DOI: 10.1016/j.surg.2009.10.012. View

11.

Charlson M, Szatrowski T, Peterson J, Gold J . Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11):1245-51. DOI: 10.1016/0895-4356(94)90129-5. View

12.

Rollins K, Javanmard-Emamghissi H, Acheson A, Lobo D . The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Ann Surg. 2018; 270(1):43-58. PMC: 6570620. DOI: 10.1097/SLA.0000000000003145. View

13.

Scarborough J, Mantyh C, Sun Z, Migaly J . Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection: An Analysis of Colectomy-Targeted ACS NSQIP. Ann Surg. 2015; 262(2):331-7. DOI: 10.1097/SLA.0000000000001041. View

14.

Van der Bij A, Frentz D, Bonten M . Gram-positive cocci in Dutch ICUs with and without selective decontamination of the oropharyngeal and digestive tract: a retrospective database analysis. J Antimicrob Chemother. 2015; 71(3):816-20. DOI: 10.1093/jac/dkv396. View

15.

Scheufele F, Schirren R, Friess H, Reim D . Selective decontamination of the digestive tract in upper gastrointestinal surgery: systematic review with meta-analysis of randomized clinical trials. BJS Open. 2020; . PMC: 7709368. DOI: 10.1002/bjs5.50332. View

16.

Lagarde S, Navidi M, Gisbertz S, van Laarhoven H, Sumpter K, Meijer S . Prognostic impact of extracapsular lymph node involvement after neoadjuvant therapy and oesophagectomy. Br J Surg. 2016; 103(12):1658-1664. DOI: 10.1002/bjs.10226. View

17.

Paun B, Cassie S, MacLean A, Dixon E, Buie W . Postoperative complications following surgery for rectal cancer. Ann Surg. 2010; 251(5):807-18. DOI: 10.1097/SLA.0b013e3181dae4ed. View

18.

Hyoju S, Klabbers R, Aaron M, Krezalek M, Zaborin A, Wiegerinck M . Oral Polyphosphate Suppresses Bacterial Collagenase Production and Prevents Anastomotic Leak Due to Serratia marcescens and Pseudomonas aeruginosa. Ann Surg. 2017; 267(6):1112-1118. PMC: 5540820. DOI: 10.1097/SLA.0000000000002167. View

19.

Cavallaro P, Bordeianou L . Implementation of an ERAS Pathway in Colorectal Surgery. Clin Colon Rectal Surg. 2019; 32(2):102-108. PMC: 6395097. DOI: 10.1055/s-0038-1676474. View

20.

Li J, Zhang Y, Hu D, Gong T, Xu R, Gao J . Impact of postoperative complications on long-term outcomes of patients following surgery for gastric cancer: A systematic review and meta-analysis of 64 follow-up studies. Asian J Surg. 2019; 43(7):719-729. DOI: 10.1016/j.asjsur.2019.10.007. View