Intra-abdominal infection after radical gastrectomy for gastric cancer: Incidence, pathogens, risk factors and outcomes

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Abstract
Surgical site infection, particularly intra-abdominal infection (IAI), remains a clinically important event after gastrectomy for gastric cancer. The aim of this retrospective study was to clarify the incidence, pathogens, risk factors and outcomes of IAI following gastrectomy for gastric cancer. The study cohort was 1835 patients who underwent gastrectomy for gastric cancer from January 2011 through December 2016. The incidence, pathogens, and treatment outcomes of IAI were examined, and the risk factors were identified using univariate and multivariate analyses. In total, 73 patients (4.0%) developed IAI after radical gastrectomy. Bacterial culture in these patients showed that Gram-negative bacilli, such as Escherichia coli and Klebsiella pneumonia were the most common pathogens. Multivariate analysis identified that combined multi-organ resection (Odds Ratio [OR] = 2.262, 95% confidence interval [CI]: 1.114-4.596, P = 0.024), and body mass index (BMI) ≥ 25 kg/m2 (OR = 1.968, 95% CI: 1.107-3.500, P = 0.021) were independent risk factors. Three patients (4.1%) developed IAI who died from sepsis and/or multiple-organ failure, which was significantly higher than in the remaining 1762 patients without IAI (5 cases, 0.3%, P = 0.003). Moreover, IAI required more re-operations (5.5% vs 0.8%, P = 0.005) and longer post-operative hospital stays (23.3 days vs 11.2 days, P < 0.001) compared without IAI. IAI is a major complication after radical gastrectomy for gastric cancer, and associated with combined multi-organ resection and a BMI ≥ 25 kg/m2; thus, meticulous surgical procedures need to be performed in patients with these specific risk factors.

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