The Elephant in the Operating Room

Editor’s Comment: For this post I’d like to introduce guest blogger Michael Goldfarb, MD, who has generously agreed to contribute a few posts leveraging his surgical expertise and passion for the prevention of SSI. With a diverse career spanning the United States Army, hospital adminstration and leadership positions, and private and academic surgical practice, Dr. Goldfarb provides a unique perspective on the challenges of SSI. The post below is abstracted from an article Dr. Goldfarb wrote previously, entitled: “The Elephant in the OR,” General Surgery News, May 2014, volume 41, Issue 5.

Key Takeaway Points:

  • In patients with infectious complications after surgery for colorectal cancer, the survival rate was more than 50% lower than in patients without infections.
  • The presence of postoperative complications was an independent factor associated with a worse overall survival and a higher overall recurrence rate in colorectal cancer patients. Also, there is a significant association between colorectal anastomotic leak and reduced long-term cancer-specific survival.
  • What biological mechanisms might underlie this link? Consider the following:
    • Host–tumor interactions under surgical stress may act synergistically as potent tumor growth factors, and may thus influence long-term survival. Controlling surgical insults and/or regulating perioperative inflammatory responses may therefore lead to new therapeutic approaches for controlling disease recurrence.
    • Intravital microscopy showed that cancer cells adhered directly on top of arrested neutrophils, indicating that neutrophils may act as a bridge to facilitate interactions between cancer cells and the liver parenchyma.
  • If surgeons accept the notion that postoperative infection reduces survival, then certain algorithms in surgery should be modified.

Continue reading “The Elephant in the Operating Room”