Short-term outcomes of rectal resection for cancer with mechanical bowel preparation and oral antibiotics versus mechanical bowel preparation alone

Abstract

Introduction: Surgical site infections (SSI) are the most common complications after rectal surgery, leading to increased postoperative morbidity, mortality, length of stay, healthcare costs. To reduce SSI and provide better short-term outcomes mechanical bowel preparation (MBP) and oral antibiotics (OA) have been proposed. We aim to compare short-term outcomes and to investigate the impact of MBP with or without OA on postoperative complications in patients undergoing rectal resections for cancer.

Materials and Methods: This is a single center superiority randomized controlled trial comparing short-term outcomes of MBP+OA versus MBP alone in patients with rectal resection for cancer. Eligible patients (n = 98) were randomized in 1:1 allocation ratio to MBP+OA group (n=51) or MBP group (n = 47). Primary endpoint was SSI assessed within 30 days after rectal resection.

Results: SSI rate was 13,7 % in MBP+OA group, 34,0 % in MBP group (risk ratio - 0.403, 95 % CI: 0.182-0.893, p = 0.018). Incidence of anastomotic leak was 3,9 % versus 23,4 % in MBP+OA and MBP group respectively (risk ratio - 0.168, 95 % CI: 0.039-0.717, p = 0.005). There were no significant differences in wound infection rate, intraabdominal/pelvic abscesses rate, rate of other postoperative complications.

Conclusion: Combined preoperative preparation with MBP and OA leads to fewer rate of SSI and particularly anastomotic leak rate in patients with rectal cancer surgery compared to MBP alone.