Surgical Site Infections in Gynecologic Oncology

Michael Johnston^*
*Correspondence: Michael Johnston, Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria, Email:

Keywords

Gynecologic oncology • Surgical site infections • Prevention

Introduction

Surgical site infections constitute a substantial concern in gynecologic oncology surgeries due to their potential to complicate postoperative recovery, prolong hospital stays, and increase healthcare costs. These infections arise from microbial contamination of surgical wounds, leading to local inflammation, tissue damage, and systemic complications. Gynecologic oncology surgeries, which encompass a range of procedures from minimally invasive interventions to extensive abdominal surgeries, pose specific challenges in infection prevention and management [1].

Literature Review

Factors contributing to the development of SSIs in gynecologic oncology surgeries include patient-related variables such as obesity, diabetes mellitus, immunosuppression, and pelvic infections, as well as surgical factors like operative duration, type of surgery, and adherence to infection control protocols. Prevention strategies encompass preoperative optimization, including patient education, nutritional support, and smoking cessation, along with intraoperative measures such as antibiotic prophylaxis and meticulous surgical technique. Postoperative management involves early recognition of SSIs through surveillance protocols and prompt initiation of targeted antimicrobial therapy and wound care interventions [2].

The implications of SSIs in gynecologic oncology surgeries extend beyond immediate clinical consequences to impact treatment outcomes, including delays in adjuvant therapies and potential compromises in oncologic outcomes. Addressing SSIs requires a multidisciplinary approach involving surgeons, infectious disease specialists, nurses, and pharmacists to implement evidence-based practices and optimize patient safety.

Discussion

Surgical site infections in gynecologic oncology represent a significant concern due to their potential to impact postoperative recovery, treatment outcomes, and patient morbidity. This paper explores the epidemiology, risk factors, prevention strategies, management approaches, and implications of SSIs in the context of gynecologic oncology surgeries [3]. Gynecologic oncology surgeries encompass a range of procedures performed to diagnose, stage, and treat cancers of the female reproductive system, including ovarian, uterine, cervical, vaginal, and vulvar cancers. These surgeries can vary from minimally invasive procedures such as laparoscopy and roboticassisted surgery to more extensive open surgeries like radical hysterectomy or debulking procedures for advanced disease. Despite advances in surgical techniques and perioperative care, SSIs remain a significant complication, affecting up to 15% of patients undergoing gynecologic oncology surgeries.

The incidence of SSIs varies depending on multiple factors, including the type of surgical procedure, patient-specific factors such as age, comorbidities, and immune status, as well as adherence to infection prevention protocols. SSIs can occur as superficial infections involving the skin and subcutaneous tissue or deep infections involving deeper structures such as the pelvic cavity or intra-abdominal space. Postoperative SSIs not only prolong hospital stays and increase healthcare costs but can also compromise treatment outcomes by delaying adjuvant therapies or necessitating additional interventions. Several factors contribute to the risk of developing SSIs in gynecologic oncology surgeries. Patient-related factors include obesity, diabetes mellitus, smoking, malnutrition, immunosuppression, and prior history of pelvic infections [4]. Surgical factors such as prolonged operative time, contaminated surgical instruments or implants, inadequate skin preparation, and perioperative blood transfusions also increase the risk of SSIs. Additionally, the type of surgical approach (open versus minimally invasive) and the extent of surgical resection or lymph node dissection play significant roles in determining the likelihood of developing SSIs.

Preventing SSIs in gynecologic oncology surgeries requires a multifaceted approach that begins preoperatively and extends into the postoperative period. Preoperative optimization of patient health, including glycemic control in diabetic patients, smoking cessation, and nutritional support, helps minimize the risk of wound complications. Adequate preoperative skin preparation with antiseptic solutions such as chlorhexidine or povidone-iodine reduces skin colonization with potential pathogens. During surgery, adherence to sterile techniques, proper surgical hand hygiene, and meticulous surgical technique minimize the introduction of contaminants into the surgical site. Intraoperative measures such as antibiotic prophylaxis administered within one hour before incision, appropriate selection of antibiotics based on local resistance patterns, and maintenance of normothermia contribute to reducing the risk of SSIs [5]. Enhanced recovery protocols and minimally invasive surgical techniques, which minimize tissue trauma and reduce postoperative pain and inflammatory response, may also lower the incidence of SSIs compared to traditional open surgeries.

Postoperatively, early detection of signs and symptoms of infection, including wound erythema, warmth, swelling, and purulent discharge, facilitates prompt initiation of appropriate antimicrobial therapy and wound care. Close monitoring of surgical wounds and adherence to evidence-based guidelines for wound management, including the use of wound dressings and surgical site surveillance protocols, are essential components of infection prevention strategies.

Conclusion

SSIs represent a significant and preventable complication of gynecologic oncology surgeries, impacting patient morbidity, treatment outcomes, and healthcare costs. Comprehensive infection prevention strategies, including preoperative optimization, adherence to sterile techniques, appropriate antibiotic prophylaxis, and vigilant postoperative monitoring, are essential to reduce the incidence of SSIs.

Acknowledgement

None.

Conflict of Interest

None.

References

1. Kim, Joo-Hee, Eun-Jung Kim, Byung-Kwan Seo and Sanghun Lee, et al. "Electroacupuncture for chemotherapy-induced peripheral neuropathy: study protocol for a pilot multicentre randomized, patient-assessor-blinded, controlled trial." Trials 14 (2013): 1-7.

Google Scholar, Crossref, Indexed at

2. Youn, Bo-Young. "Integrative Medicine in Diagnostics: Current Advances and Future Prospects." Diagnostics 13 (2023): 3052.

Google Scholar, Crossref, Indexed at

3. Garcia, Patricia, Stephen P. Ma, Shreya Shah and Margaret Smith, et al. "Artificial Intelligence–Generated Draft Replies to Patient Inbox Messages." JAMA Netw Open 7 (2024): e243201-e243201.

Google Scholar, Crossref, Indexed at

4. Bray, Freddie, Jacques Ferlay, Isabelle Soerjomataram and Rebecca L. Siegel, et al. "Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries." CA Cancer J Clin 68 (2018): 394-424.

Google Scholar, Crossref, Indexed at

5. Schwartz, Lawrence H., Lesley Seymour, Saskia Litière and Robert Ford, et al. "RECIST 1.1–Standardisation and disease-specific adaptations: Perspectives from the RECIST Working Group." Euro J Cancer 62 (2016): 138-145.

Google Scholar, Crossref, Indexed at

6. Kagabu, Masahiro, Takayuki Nagasawa, Chie Sato and Yasuko Fukagawa, et al. "Immunotherapy for uterine cervical cancer using checkpoint inhibitors: future directions." Int J Mol Sci 21 (2020): 2335.

Google Scholar, Crossref, Indexed at