Postoperative peritoneal infection and recurrence of colorectal cancer: the postoperative inflammatory response and angiogenesis as mechanisms responsible for this association: LTP31


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Abstract

Aim:Post-operative intra-abdominal infection is associated with higher rates of recurrence and cancer-specific mortality in patients with colorectal cancer. We hypothesised that the greater inflammatory response in patients with an intra-abdominal abscess or anastomotic leak is associated to an increased post-operative angiogenesis.Method:Prospective cohorts study with matched-controls. Patients with post-operative intraabdominal infection (group 1; n = 23) after colorectal cancer resection were compared to patients without complications (group 2; n = 23). IL-6 and VEGF levels were measured in serum and peritoneal fluid at baseline, 48 hours and day 4.Results:IL6 levels on day 4 were higher in group 1 in serum (1276 ± 3524 vs 4.83 ± 7.75 pg/ml; P = 0.005) and peritoneal fluid (94764 ± 79491 vs 17647 ± 45231 pg/ml; P = 0.006). VEGF levels were also higher in group 1 at 48 hours and day 4 in serum (3388 ± 4016 vs 498 ± 376 pg/ml; P < 0.001) and peritoneal fluid (7281 ± 3872 vs 801 ± 1001 pg/ml; P < 0.001). The 3-year cumulative recurrence rate was higher in group 1 (48% vs 18%; log rank test P = 0.003).Conclusion:Post-operative intra-abdominal infection induces an increased inflammatory and angiogenic response in patients undergoing surgery for colorectal cancer. This association may be responsible for the increased tumour recurrence observed in these patients.

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