Local Antibiotic Therapy in Rectal Cancer Surgery
Languages of publication
Infectious complications and their consequences are still key issues in rectal cancer surgery. Currently, intravenous antibiotic administration is a recognized method for lowering the rate of these complications.The aim of the study was to assess the efficacy of complementary application of a gentamicin-impregnated sponge in the perineal wound or in the vicinity of intestinal anastomosis after abdominoperineal resection or low anterior resection.Material and methods. 112 patients with primary rectal cancer were enrolled in this study. 42 patients were treated with a gentamicin sponge and drainage (group A) and 70 individuals were treated with drainage alone (group B). In the aforementioned groups a routine short-term regimen of antibiotic prophylaxis was used. We applied gentamicin-impregnated sponges in 27 patients in whom anterior resection was performed and in 15 patients from the abdominoperineal resection group (64% and 36%, respectively). In the control group, 44 anterior resections and 26 abdominoperineal resections were carried out (63% and 37%, respectively).Results. We did not observe statistically significant differences in the incidence of suppurative complications (intraabdominal abscess, perineal wound infection): 4 cases (9.52%) in group A and 9 (12.58%) in group B and anastomotic leakage with clinical manifestation after low anterior resection: 1 case (3.7%) in group A and 2 (4.5%) in group B. Postoperative fever of unknown origin was noted more often in group B: 23 patients (32.8%) versus 10 patients (23.8%) in group A and this difference was statistically significant (p<0.05). Hospitalization after surgery was also significantly longer in group B (9-37 days, median 11 days) as compared with group A (8-26 days, median 13 days) (p<0.05).Conclusions. Local antibiotic therapy in rectal cancer surgery lowered the incidence of postoperative fever of unknown origin and permitted shorter hospitalization after surgery. Local gentamicin application in rectal cancer surgery did not change significantly the rate of infectious complications.
1 - 12 - 2012
09 - 02 - 2013
- 1. B errino F, Sant M, Verdechia R et al.: Cancer survival in Europa. Irac. Sc. Publ, No13, Lyon, 1994.
- 2. Hackett TP, Cassem NH, Raker JW: Patient delay in cancer. N Engl J Med 1973; 288: 14.
- 3. S medh K, Olsson L, Johansson H et al.: Reduction of postoperative morbidity and mortality in patients with rectal cancer following the introduction of colorectal unit. Br J Surg 2001; 88(2): 273-77.
- 4. Hout J,Gibbsons R: Efficacy of preoperative mechanical preparation of the colon. Ann Surg 1972; 176: 227.
- 5. Nowacki M i wsp.: Rola antybiotyku w przygotowaniu przedoperacyjnym chorych na raka jelita grubego. Pol Przegl Chir 1980; 52(4): 311-15.
- 6. N owicki A, Ziętek Z: Zakażenie i profilaktyczne leczenie antybiotykami w chirurgii raka jelita grubego. Pol Tyg Lek 1991; XLVI: 180.
- 7. Gottrup F, Diederich P, Sorsen K: Prophylaxis with whole gut irrigation and antimicrobials in colorectal surgery. A prospective, randomized double- blind clinical trial. Am J Surg 1985; 149: 317.
- 8. Hares MM, Williams JA: The effect of bowel preparation on colonic surgery.World J Surg 1982; 6: 175.[PubMed][Crossref]
- 9. Gruessner U, Clemens M, Pahlplatz PV: Impprovement of perineal wound healing by local administration of gentamicin-inpregnated collagen fleeces after abdominoperineal excision of rectal cancer. Am J Surg 2001; 182: 502.
- 10. Rosen HR, Marczell AP: Local gentamicin application for perineal wound healing following abdominoperineal rectum excision. Am J Surg 1991; 162: 438.
- 11. Dowdall JF, Maguire D, McAnena OJ: Experience of surgery for rectal cancer with total mesorectal excision in a general surgical practice. Br JSurg 2002; 89(8): 946-47.
- 12. Jatzko GR, Jogoditsch M, Lizborg PH et al.: Long - term results of radical surgery for rectal cancer: multivariate analisis of prognostic factors influencing survival and local recurrence. Eur JSurg Oncol 1999; 25: 284-91.[Crossref]
- 13. K aranjia ND, Corder AP, Bearn P, Heald RJ: Leakage from stapled anastomosis after total mesorectal excision for carcinoma of the rectum. Br JSurg 1994; 81: 1224-26.
- 14. T ersigni R, Alessandroni L, Baiano G et al.: Anastomosis dehiscence in anterior resection of the rectum with total excision of the mesorectum. ChirItal 2002; 54: 179-84.
- 15. Fielding LP, Stevard-Brown S: Anastomotic integrity after operations for large bowel cancer: a multicenter study. Br Med J 1980; 281: 411.
- 16. Nesbakken A, Nygaard K, Lunde OC: Anastomotic leak following mesorectal excision for rectal cancer: true incidence and diagnostic challenges. Colorectal Dis 2005; 7 (6): 576-81.[Crossref][PubMed]
- 17. Williams NS: Surgical treatment of rectal cancer. Surgery of the anus, rectum and colon.Red.MRB Keigley I N.S.Williams.WB Saunders London 1993; 921: 1021.
Publication order reference