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. 2025 Feb;32(2):1043-1053.
doi: 10.1245/s10434-024-16489-x. Epub 2024 Nov 21.

Surgical Site Infections in Simultaneous Colorectal and Liver Resections for Metastatic Colorectal Adenocarcinoma

Lauren E Schleimer #  1   2 , Lynn Hakki #  1   2 , Kenneth Seier  3 , Susan K Seo  4 , Nina Cohen  4 , Shauna Usiak  5 , Tiffany Romero  5 , Mini Kamboj  4   5 , Crisanta Ilagan  6 , Lily V Saadat  1 , Remo Alessandris  1 , Kevin C Soares  1 , Jeffrey Drebin  1 , Alice C Wei  1 , Maria Widmar  1 , Iris H Wei  1 , J Joshua Smith  1 , Emmanouil P Pappou  1 , Philip B Paty  1 , Garrett M Nash  1 , William R Jarnagin  1 , Julio Garcia-Aguilar  1 , Mithat Gonen  3 , T Peter Kingham  1 , Martin R Weiser  1 , Michael I D'Angelica  7
Affiliations

Surgical Site Infections in Simultaneous Colorectal and Liver Resections for Metastatic Colorectal Adenocarcinoma

Lauren E Schleimer et al. Ann Surg Oncol. 2025 Feb.

Abstract

Background: Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement.

Methods: Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria. Univariable and multivariable logistic regression evaluated associations with NSQIP 30-day organ-space SSIs.

Results: In 580 procedures, the rate of 30-day organ-space SSIs was 16% (n = 94) using NSQIP criteria and 11% (n = 64) using NHSN criteria; 4% (n = 24) had incisional SSIs by both criteria. Most organ-space SSIs were perihepatic, and a minority were associated with bile (26%) or anastomotic (15%) leak. Independent risk factors for organ-space SSIs included major liver resection, upper abdominal (compared with lower abdominal/pelvic) colorectal procedure, and ostomy reversal. Organ-space SSI rates increased over time by approximately 16% per calendar year (p = 0.02) despite a declining rate of major liver resection; incisional SSI rates remained low. Overall, major morbidity was 22%, with 7-day median length of stay (interquartile range 6-9) and 0.3% 90-day mortality.

Conclusion: Organ-space SSIs are a significant driver of postoperative morbidity in simultaneous liver and colorectal resections for metastatic colorectal adenocarcinoma. Our findings confirm simultaneous resection remains safe and interventions to mitigate the risk of perihepatic organ-space SSIs in high-risk patients are warranted.

Keywords: Antibiotics; Colectomy; Colorectal cancer; Hepatectomy; Ostomy; Proctectomy; Quality improvement; Surgical site infection.

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Conflict of interest statement

Disclosure. Lauren E. Schleimer, Lynn Hakki, Kenneth Seier, Susan K. Seo, Nina Cohen, Shauna Usiak, Tiffany Romero, Mini Kamboj, Crisanta Ilagan, Lily V. Saadat, Remo Alessandris, Kevin C. Soares, Maria Widmar, Iris H. Wei, Emmanouil P. Pappou, Philip B. Paty, Garrett M. Nash, William R. Jarnagin, Mithat Gonen, T. Peter Kingham, and Michael I. D’Angelica have no conflicts of interest to disclose. Jeffrey Drebin reports employment and leadership at American Regent (spouse), and stock and other ownership interests in Alnylam, Arrowhead Pharmaceuticals, and Ions Pharmaceuticals. Alice C. Wei reports consulting fees from Histosonics and institutional research funding from Ipsen. J. Joshua Smith reports travel support for fellow education from Intuitive Surgical (19/20 August 2015), serving as a clinical advisor for Guardant Health (19/20 March 2019) and Foundation Medicine (5 April 2022), serving as a consultant and speaker for Johnson & Johnson (8–10 May 2022), and serving as a clinical advisor and consultant for GlaxoSmithKline (2023). Julio Garcia-Aguilar reports consulting for Ethicon and Intuitive Surgical. Martin R. Weiser reports consulting for PrecisCa and intellectual property rights for UpToDate.

References

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