Impact of surgical site infection on short- and long-term outcomes of robot-assisted rectal cancer surgery: a two-center retrospective study.

Abstract

Purpose: Robot-assisted surgery has increasingly gained recognition in the treatment of rectal cancer. This study aimed to assess the incidence of surgical site infection (SSI) that underwent robot-assisted radical rectal cancer surgery and to evaluate their influence on patient outcomes.

Methods: A retrospective analysis was conducted on 360 patients who underwent robot-assisted radical rectal cancer surgery between 2017 and 2024 at Fujian Medical University Union Hospital and Longyan First Affiliated Hospital of Fujian Medical University. The patients were categorized into surgical site infection and non-surgical site infection groups based on the presence of surgical site infection. Baseline clinicopathological characteristics, perioperative details, and follow-up data were analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of surgical site infection, and Cox proportional hazards regression models were utilized to evaluate factors influencing overall survival.

Results: The study found that 44 out of 360 patients (12.2%) developed surgical site infection. Multivariate analysis indicated that positive perineural invasion (OR 3.59, 95% CI 1.50-8.62, P = 0.004) is an independent risk factor for SSI. Low anterior resection (OR 0.26, 95% CI 0.09-0.73, P = 0.011), preservation of the left colonic artery (OR 0.20, 95% CI 0.09-0.44, P < 0.001), and neoadjuvant therapy (OR 0.45, 95% CI 0.23-0.89, P = 0.021) were associated with reduced risks of SSI. The presence of SSI was significantly associated with a reduction in overall survival (HR 3.43, 95% CI 1.30-9.04, P = 0.012). The risk of developing surgical site infection increases with the number of risk factors, and patients with two or more risk factors have a much higher risk of developing SSI.

Conclusions: This study identified perineural invasion as an independent risk factor for the development of SSI that underwent robot-assisted radical rectal cancer surgery. Low anterior resection, preservation of the left colonic artery, and neoadjuvant therapy emerged as protective factors. Moreover, the presence of surgical site infection was significantly correlated with poorer overall survival.