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Selective Decontamination with Oral Antibiotics in Colorectal Surgery: 90-day Reintervention Rates and Long-term Oncological Follow-up

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Oral antibiotics (OAB) in colorectal surgery have been shown to reduce surgical site infections (SSIs) and possibly anastomotic leakage. However, evidence on long-term follow-up, reintervention rates and 5-year oncological follow-up is lacking. The current study aims at elucidating this knowledge gap.

Methods

This study evaluated the long-term effectiveness of perioperative ‘Selective decontamination of the digestive tract’ (SDD) in colorectal cancer surgery. The primary outcome was anastomotic leakage within 90 days, secondary outcomes included infectious complications, reinterventions, readmission, hospital stay, and 5-year overall and disease-free-survival. Statistical analysis including univariate and multivariate analysis was performed to identify predictors of 90-day outcomes, and Kaplan–Meier survival analysis was used for the 5-year survival outcomes.

Results

In total 455 patients were analyzed, 228 participants in the SDD group and 227 in the control group. Anastomotic leakage rate was not statistically different between the SDD and control group (6.6% versus 9.7%). One or more infectious complications occurred in 15.4% of patients in the SDD group and in 28.2% in the control group (OR 0.46, 95% C.I. 0.29 – 0.73). In the SDD group 8,8% of patients required a reintervention compared to 16,3% of patients in the control group (OR 0.47, 95% C.I. 0.26 – 0.84). After multivariable analysis SDD remained significant in reducing both infectious complications and reinterventions after 90-days follow-up. There was no difference between SDD and control group in 5-year overall survival and disease-free-survival.

Conclusion

SDD as OAB is effective in reducing 90-days postoperative infectious complications and reinterventions. As such, SDD as standard OAB in elective colorectal surgery is highly recommended.

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Data Availability

Data available on request from the corresponding author.

References

  1. Abis, G.S.A., et al., Randomized clinical trial of selective decontamination of the digestive tract in elective colorectal cancer surgery (SELECT trial). Br J Surg, 2019. 106(4): p. 355-363.

    Article  CAS  PubMed  Google Scholar 

  2. Koskenvuo, L., et al., Mechanical and oral antibiotic bowel preparation versus no bowel preparation for elective colectomy (MOBILE): a multicentre, randomised, parallel, single-blinded trial. Lancet, 2019. 394(10201): p. 840-848.

    Article  CAS  PubMed  Google Scholar 

  3. Espin Basany, E., et al., Preoperative oral antibiotics and surgical-site infections in colon surgery (ORALEV): a multicentre, single-blind, pragmatic, randomised controlled trial. Lancet Gastroenterol Hepatol, 2020. 5(8): p. 729-738.

    Article  PubMed  Google Scholar 

  4. Yang, J., et al., The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta-analysis. J Surg Oncol, 2020. 121(8): p. 1283-1297.

    Article  CAS  PubMed  Google Scholar 

  5. Wang, S., et al., Adverse Effects of Anastomotic Leakage on Local Recurrence and Survival After Curative Anterior Resection for Rectal Cancer: A Systematic Review and Meta-analysis. World J Surg, 2017. 41(1): p. 277-284.

    Article  PubMed  Google Scholar 

  6. Zimlichman, E., et al., Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med, 2013. 173(22): p. 2039-46.

    Article  PubMed  Google Scholar 

  7. Keenan, J.E., et al., Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs. J Am Coll Surg, 2015. 221(2): p. 404-14.e1.

    Article  PubMed  Google Scholar 

  8. Papp, G., et al., Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial. Br J Surg, 2021. 108(3): p. 271-276.

    Article  CAS  PubMed  Google Scholar 

  9. Rollins, K.E., et al., The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-analysis. Ann Surg, 2019. 270(1): p. 43-58.

    Article  PubMed  Google Scholar 

  10. Grewal, S., et al., Oral Antibiotic Prophylaxis Reduces Surgical Site Infection and Anastomotic Leakage in Patients Undergoing Colorectal Cancer Surgery. Biomedicines, 2021. 9(9).

  11. Morks, A.N., et al., Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis, 2013. 15(5): p. e271-5.

    Article  CAS  PubMed  Google Scholar 

  12. Tan, W.P., et al., Anastomotic leaks after colorectal anastomosis occurring more than 30 days postoperatively: a single-institution evaluation. Am Surg, 2014. 80(9): p. 868-72.

    Article  PubMed  Google Scholar 

  13. Borstlap, W.A.A., et al., Anastomotic Leakage and Chronic Presacral Sinus Formation After Low Anterior Resection: Results From a Large Cross-sectional Study. Ann Surg, 2017. 266(5): p. 870-877.

    Article  PubMed  Google Scholar 

  14. Roos, Daphne et al. “Perioperative selective decontamination of the digestive tract (SDD) in elective colorectal surgery.” Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract vol. 13,10 (2009): 1839-44.

    Article  PubMed  Google Scholar 

  15. Woodfield, J.C., et al., Strategies for Antibiotic Administration for Bowel Preparation Among Patients Undergoing Elective Colorectal Surgery: A Network Meta-analysis. JAMA Surg, 2021.

  16. Bona, S., et al., Introducing an enhanced recovery after surgery program in colorectal surgery: a single center experience. World J Gastroenterol, 2014. 20(46): p. 17578-87.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Primrose, John N et al. “Effect of 3 to 5 years of scheduled CEA and CT follow-up to detect recurrence of colorectal cancer: the FACS randomized clinical trial.” JAMA vol. 311,3 (2014): 263-70. doi:https://doi.org/10.1001/jama.2013.285718

    Article  CAS  PubMed  Google Scholar 

  18. Henneman, Daniel et al. “Safety of elective colorectal cancer surgery: non-surgical complications and colectomies are targets for quality improvement.” Journal of surgical oncology vol. 109,6 (2014): 567-73. doi:https://doi.org/10.1002/jso.23532

    Article  PubMed  Google Scholar 

  19. Yang, S.Y., et al., Late anastomotic leakage after anal sphincter saving surgery for rectal cancer: is it different from early anastomotic leakage? Int J Colorectal Dis, 2020. 35(7): p. 1321-1330.

    Article  PubMed  Google Scholar 

  20. Ju, H.E., et al., High incidence rate of late anastomosis leakage in patients for rectal cancer after neoadjuvant chemoradiotherapy: A comparative study. Asian J Surg, 2021.

  21. Kverneng Hultberg, D., et al., The Impact of Anastomotic Leakage on Long-term Function After Anterior Resection for Rectal Cancer. Dis Colon Rectum, 2020. 63(5): p. 619-628.

    Article  PubMed  Google Scholar 

  22. Mirnezami, A., et al., Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg, 2011. 253(5): p. 890-9.

    Article  PubMed  Google Scholar 

  23. Koedam, T.W.A., et al., Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence. Ann Surg, 2020.

    Google Scholar 

  24. Kulu, Y., et al., Anastomotic leakage is associated with impaired overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg Oncol, 2015. 22(6): p. 2059-67.

    Article  PubMed  Google Scholar 

  25. Bogner, A., et al., Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis. Langenbecks Arch Surg, 2022.

    Google Scholar 

  26. McDermott, F.D., et al., Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg, 2015. 102(5): p. 462-79.

    Article  CAS  PubMed  Google Scholar 

  27. Huisman, D.E., et al., LekCheck: A Prospective Study to Identify Perioperative Modifiable Risk Factors for Anastomotic Leakage in Colorectal Surgery. Ann Surg, 2022. 275(1): p. e189-e197.

    Article  PubMed  Google Scholar 

  28. Shobar, R.M., et al., The Effects of Bowel Preparation on Microbiota-Related Metrics Differ in Health and in Inflammatory Bowel Disease and for the Mucosal and Luminal Microbiota Compartments. Clin Transl Gastroenterol, 2016. 7: p. e143.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Cong, J., et al., A Pilot Study: Changes of Gut Microbiota in Post-surgery Colorectal Cancer Patients. Front Microbiol, 2018. 9: p. 2777.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Taur, Y., et al., Intestinal domination and the risk of bacteremia in patients undergoing allogeneic hematopoietic stem cell transplantation. Clin Infect Dis, 2012. 55(7): p. 905-14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Shogan, B.D., et al., Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci Transl Med, 2015. 7(286): p. 286ra68.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Olivas, A.D., et al., Intestinal tissues induce an SNP mutation in Pseudomonas aeruginosa that enhances its virulence: possible role in anastomotic leak. PLoS One, 2012. 7(8): p. e44326.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gaines, S., et al., Gut microbiome influences on anastomotic leak and recurrence rates following colorectal cancer surgery. Br J Surg, 2018. 105(2): p. e131-e141.

    Article  CAS  PubMed  Google Scholar 

  34. Hyoju, S.K., et al., Oral Polyphosphate Suppresses Bacterial Collagenase Production and Prevents Anastomotic Leak Due to Serratia marcescens and Pseudomonas aeruginosa. Ann Surg, 2018. 267(6): p. 1112-1118.

    Article  PubMed  Google Scholar 

  35. Shakhsheer, B.A., et al., Morphine Promotes Colonization of Anastomotic Tissues with Collagenase - Producing Enterococcus faecalis and Causes Leak. J Gastrointest Surg, 2016. 20(10): p. 1744-51.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Reuvers, J.R.D., et al., Gut Proteobacteria levels and colorectal surgical infections: SELECT trial. Br J Surg, 2022.

    Google Scholar 

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Acknowledgements

Collaborators (alphabetical order)

Members of the SELECT trial study group: G. S. A. Abis1, Y. I. Z. Acherman2, F. C. den Boer3, H. J. Bonjer4, M. van Egmond4, G. Kazemier4, N. de Korte2, S. J. Oosterling2, J. R. D. Reuvers2, J. Scholten2, D. J. A. Sonneveld5, H. B. A. C. Stockmann2, K. van Stralen2, J. B. Tuynman4.

Meander Medisch Centrum, Amersfoort

Spaarne Gasthuis, Haarlem/Hoofddorp

Zaans Medisch Centrum, Zaandam

Amsterdam University Medical Centers, AUMC, Amsterdam

Dijklander Ziekenhuis, Hoorn

Funding

This study was funded by the Dutch Digestive Foundation, Spaarne Gasthuis Academy Fund. The funder had no role in study design, data collection, data analysis, data interpretation or writing of the report.

Author information

Authors and Affiliations

  1. Department of Surgery, Spaarne Gasthuis, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands

    J. Scholten, J. R. D. Reuvers, H. B. A. C. Stockmann & S. J. Oosterling

  2. Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    J. Scholten, J. R. D. Reuvers & M. van Egmond

  3. Department of Molecular Cell Biology and Immunology, Amsterdam University Medical Centers, De Boelelaan 1108, 1081 HZ, Amsterdam, The Netherlands

    J. R. D. Reuvers, M. van Egmond, H. J. Bonjer & G. Kazemier

  4. Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, The Netherlands

    J. R. D. Reuvers, M. van Egmond & G. Kazemier

  5. Spaarne Gasthuis Academy, Boerhaavelaan 22, 2035 RC, Haarlem, The Netherlands

    K. J. van Stralen

  6. Department of Surgery, Meander Medisch Centrum, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands

    G. S. A. Abis

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  1. J. Scholten
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Consortia

on behalf of the SELECT study group

  • Y. I. Z. Acherman
  • , F. C. den Boer
  • , N. de Korte
  • , D. J. A. Sonneveld
  •  & J. B. Tuynman

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Correspondence to J. Scholten.

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Members of the SELECT trial study group can be found under the heading Collaborators.

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Scholten, J., Reuvers, J.R.D., Stockmann, H.B.A.C. et al. Selective Decontamination with Oral Antibiotics in Colorectal Surgery: 90-day Reintervention Rates and Long-term Oncological Follow-up. J Gastrointest Surg 27, 1685–1693 (2023). https://doi.org/10.1007/s11605-023-05746-1

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