552 Background: This study’s aim was to determine the incidence and date of presentation of organ space SSI (in this setting most likely due to anastomotic leak or pelvic abscess) in rectal cancer resection patients. A second purpose was to determine which variable(s) impacted the timing of the presentation. Methods: The NSQIP database was queried from 2007 to 2011 for elective rectal cancer resections. Exclusion criteria included; ASA 5 status, preoperative(preop) shock/sepsis, SIRS, and recent surgery. Demographic parameters, comorbidities, lab data, and incidence and timing of organ space SSI were assessed. The statistical methods used were Fisher’s exact test (categorical variables) and Wilcoxon’s rank tests (continuous variables). Results: 8,093 rectal cancer patients were identified (Male/Female; 60.1%/39.9%; median age, 60; APR, 28 %; sphincter saving procedures,72%). The incidence of organ space SSI was 6 % (485 patients; 2.7% presented before and 3.3% after discharge). The rate was significantly greater for men, younger patients (< 60), smokers, sphincter saving resections (vs. APR). Preop radiotherapy (RT) did not increase the rate of and stomas did not protect against the formation of organ space SSI. The mean date of detection was 14.6±7.3 days after surgery (Mean±SD). A further delay was noted in those who had preop RT regardless of the operation performed (n=184, added delay 2.7 days, p<0.05). Significant delays (p<0.05) were also noted in patients that had APR (n=112, mean delay 2.4days), stoma formation (n=285, mean delay 1.6days) and open surgery (n=368, mean delay 1.8 days). Multivariate analysis revealed preop RT (p=0.0002) and APR (p=0.0258) as independent risk factors for delayed presentation. Conclusions: Most organ space SSI after rectal cancer surgery occur after hospital discharge. The mean presentation date is about 2 weeks after surgery. Patients who received preop RT or underwent APR presented about 2.5 days later than the mean date. Rectal cancer patients should be followed closely for 3 weeks as regards organ space SSI.
Extent of Mesorectal Tumor Invasion as a Prognostic Factor After Curative Surgery for T3 Rectal Cancer Patients