Risk Factors Of Intra-abdominal Infection And Its Influence On Long-term Survival After Gastric Cancer Surgery

Objective: To analyze the risk factors of postoperative intra-abdominal infection for gastric cancer,in order to reduce the incidence of postoperative intra-abdominal infection and provide effective reference for clinical targeted intervention and treatment;The influence of postoperative intra-abdominal infection on long-term survival of gastric cancer patients was studied based on propensity score matching.Methods: The clinical data and follow-up data of 825 patients with gastric cancer admitted to our hospital from January 2010 to September 2016 were selected.Chi-square test and Fisher’s test were used for univariate analysis,and Logistic regression was used for multivariate analysis of risk factors for postoperative intra-abdominal infection of gastric cancer.A 1:2 propensity score matching method was used to reduce selection bias.Kaplan-Meier method and Log-rank test were used to analyze the influence of intra-abdominal infection on prognosis before and after matching.Cox multivariate regression was used to study the influence of various variables on prognosis before and after matching.Results: A total of 825 patients were included in this study,of which 57 patients developed postoperative intra-abdominal infection.Multivariate logistic regression analysis showed: preoperative underlying disease(OR: 1.934,95% CI: 1.094-3.418,P=0.023),perioperative blood transfusion(OR: 2.073,95% CI: 1.031-4.170,P=0.041),the tumor is located in the upper third of the stomach(OR: 2.207,95% CI: 1.150-4.233,P=0.017),tumor size ≥ 4 cm(OR: 3.581,95% CI: 1.505-8.523,P=0.004)were an independent risk factor for postoperative intra-abdominal infection in patients with gastric cancer.After propensity score matching,a total of 53 pairs of 159 patients were included in the study,including 106 patients in the non-abdominal infection group and 53 patients in the intra-abdominal infection group.Kaplan-Meier method and log-rank test showed that before matching,the 5-year cumulative recurrence-free survival rates of the non-abdominal infection group and the intra-abdominal infection group were respectively 50.4% and 28.6%(P<0.05),and the 5-year cumulative overall survival rates were respectively 48.5% and 26.4%(P<0.05),the difference between the groups was statistically significant.After matching,the 5-year cumulative recurrence-free survival rate of the non-abdominal infection group and the intra-abdominal infection group were respectively 47.3% and 29.0%(P<0.05),and the 5-year cumulative overall survival rate were respectively 46.0% and 26.9%(P<0.05),The difference between the groups was statistically significant.Cox multivariate regression model showed that intra-abdominal infection(P=0.014 before matching,P=0.029 after matching),perioperative blood transfusion(P=0.002 before matching,P=0.049 after matching),TNM staging(P=0.001 before matching,P=0.007 after matching)were independent risk factors for recurrence free survival of gastric cancer patients.intra-abdominal infection(P =0.033 before matching,P=0.048 after matching),perioperative blood transfusion(P=0.002 before matching,P=0.047 after matching),TNM staging(P=0.001 before matching,P=0.024 after matching)were independent risk factors for postoperative overall survival in patients with gastric cancer.Conclusion: Preoperative basic diseases,perioperative blood transfusion,tumor location(upper 1/3),and tumor size≥4cm are independent risk factors for intra-abdominal infection after gastric cancer surgery.We must actively improve the preoperative preparations,adopt all available treatment plans,and try our best to avoid the occurrence of postoperative intra-abdominal infection.intra-abdominal infection,perioperative blood transfusion,TNM staging are independent risk factors for the prognosis of gastric cancer.