Introduction: The inflammatory response to a post-operative infection can increase the risk of tumour recurrence in cancer through the release of pro-inflammatory mediators. The aim of this study was review the literature to assess the relationship between post-operative complications and cancer recurrence. Methods: We performed a literature review of the mechanism of such an association and looked at evidence in different cancer subtypes. Results: A relationship has been identified for many cancer subtypes, and multiple theories have been proposed for the mechanism of this association. Methods to reduce post-operative complications may impact positively on cancer recurrence rates. Conclusion: This review demonstrates that wound complications after surgery can have significant implications for cancer patients. Strategies are required to minimize the risk of post-operative wound complications in patients undergoing cancer resection.

1.
NCRI: Cancer Fact Sheets, National Cancer Registry Ireland, 2015.
2.
WHO: Cancer Fact sheet N°297, update. World Health Organization, 2011.
3.
Jemal A, Bray F, Center MM, et al.: Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
4.
O'Leary DP, Wang JH, Cotter TG, Redmond HP: Less stress, more success? Oncological implications of surgery-induced oxidative stress. Gut 2013;62:461-470.
5.
Mangram AJ, Horan TC, Pearson ML, et al.: Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97-132; quiz 133-134; discussion 196.
6.
Chen J, Gutkin Z, Bawnik J: Postoperative infections in breast surgery. J Hosp Infect 1991;17:61-65.
7.
Cruse PJE, Foord R: The epidemiology of wound infection. A 10-year prospective study of 62,939 wounds. Surg Clin North Am 1980;60:27-40.
8.
Sørensen LT, Hørby J, Friis E, et al.: Smoking as a risk factor for wound healing and infection in breast cancer surgery. Eur J Surg Oncol 2002;28:815-820.
9.
Geerlings SE, Hoepelman AI: Immune dysfunction in patients with diabetes mellitus (DM). FEMS Immunol Med Microbiol 1999;26:259-265.
10.
Holt PG: Immune and inflammatory function in cigarette smokers. Thorax 1987;42:241-249.
11.
Nolan J, Jenkins RA, Kurihara K, Schultz RC: The acute effects of cigarette smoke exposure on experimental skin flaps. Plast Reconstr Surg 1985;75:544-549.
12.
Khansa I, Hendrick RG Jr, Shore A, et al.: Breast reconstruction with tissue expanders: Implementation of a standardized best-practices protocol to reduce infection rates. Plast Reconstr Surg 2014;134:11-18.
13.
Anaya DA, Cormier JN, Xing Y, et al.: Development and validation of a novel stratification tool for identifying cancer patients at increased risk of surgical site infection. Ann Surg 2012;255:134-139.
14.
Olsen MA, Lefta M, Dietz JR, et al.: Risk factors for surgical site infection after major breast operation. J Am Coll Surg 2008;207:326-335.
15.
Mirnezami A, Mirnezami R, Chandrakumaran K, et al.: Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: Systematic review and meta-analysis. Ann Surg 2011;253:890-899.
16.
McSorley ST, Horgan PG, McMillan DC: The impact of the type and severity of postoperative complications on long-term outcomes following surgery for colorectal cancer: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2016;97:168-177.
17.
Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H: Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: A nationwide cohort study. Ann Surg 2014;259:930-938.
18.
Alonso S, Pascual M, Salvans S, et al.: Postoperative intra-abdominal infection and colorectal cancer recurrence: A prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol 2015;41:208-214.
19.
Laurent C, Sa Cunha A, Couderc P, et al.: Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases. Br J Surg 2003;90:1131-1136.
20.
Bohle B, Pera M, Pascual M, et al.: Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery 2010;147:120-126.
21.
Salvans S, Mayol X, Alonso S, et al.: Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: An insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg 2014;260:939-943.
22.
Murthy BL, Thomson CS, Dodwell D, et al.: Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer 2007;97:1211-1217.
23.
Beecher SM, O'Leary DP, McLaughlin R, et al.: Influence of complications following immediate breast reconstruction on breast cancer recurrence rates. Br J Surg 2016;103:391-398.
24.
Yan T, Yin W, Zhou L, et al.: Postoperative fever: The potential relationship with prognosis in node negative breast cancer patients. PLoS One 2010;5:e15903.
25.
Al-Sahaf O, Wang JH, Browne TJ, et al.: Surgical injury enhances the expression of genes that mediate breast cancer metastasis to the lung. Ann Surg 2010;252:1037-1043.
26.
Jackson RM, Rice DH: Wound infections and recurrence in head and neck cancer. Otolaryngol Head Neck Surg 1990;102:331-333.
27.
Rodrigo JP, Suarez C: Prognostic significance of postoperative wound infection on head and neck cancer. Otolaryngol Head Neck Surg 1998;118:272-275.
28.
Ishikawa T, Monden N, Takishita T, et al.: Surgical site infection results in a poor prognosis for oral cancer patients. Jpn J Head Neck Cancer 2013;39:379-384.
29.
Hayashi T, Yoshikawa T, Aoyama T, et al.: Impact of infectious complications on gastric cancer recurrence. Gastric Cancer 2015;18:368-374.
30.
Lerut T, Moons J, Coosemans W, et al.: Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: Role of systematic grading of complications using the modified Clavien classification. Ann Surg 2009;250:798-806.
31.
Ohtsuka T, Kitajima Y, Takahashi T, et al.: Infectious complications after gastric cancer surgery accelerate a rapid hepatic recurrence. Hepatogastroenterology 2009;56:1277-1280.
32.
Andalib A, Ramana-Kumar AV, Bartlett G, et al.: Influence of postoperative infectious complications on long-term survival of lung cancer patients: A population-based cohort study. J Thorac Oncol 2013;8:554-561.
33.
Rueth NM, Parsons HM, Habermann EB, et al.: The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: A population-based survival analysis. Ann Surg 2011;254:368-374.
34.
Deelman HT: The part played by injury and repair in the development of cancer. Br Med J 1927;1:872-872.
35.
Bodilsen A, Bjerre K, Offersen BV, et al.: The influence of repeat surgery and residual disease on recurrence after breast-conserving surgery: A Danish Breast Cancer Cooperative Group Study. Ann Surg Oncol 2015;22(Suppl 3):S476-485.
36.
Yamaguchi K, Takagi Y, Aoki S, et al.: Significant detection of circulating cancer cells in the blood by reverse transcriptase-polymerase chain reaction during colorectal cancer resection. Ann Surg 2000;232:58-65.
37.
Berguer R, Bravo N, Bowyer M, et al.: Major surgery suppresses maximal production of helper T-cell type 1 cytokines without potentiating the release of helper T-cell type 2 cytokines. Arch Surg 1999;134:540-544.
38.
Goldfarb Y, Ben-Eliyahu S: Surgery as a risk factor for breast cancer recurrence and metastasis: Mediating mechanisms and clinical prophylactic approaches. Breast Dis 2006;26:99-114.
39.
Fortner JG: Inadvertent spread of cancer at surgery. J Surg Oncol 1993;53:191-196.
40.
Bogden AE, Moreau JP, Eden PA: Proliferative response of human and animal tumours to surgical wounding of normal tissues: Onset, duration and inhibition. Br J Cancer 1997;75:1021-1027.
41.
Dvorak HF, Brown LF, Detmar M, Dvorak AM: Vascular permeability factor/vascular endothelial growth factor, microvascular hyperpermeability, and angiogenesis. Am J Pathol 1995;146:1029-1039.
42.
Yu N, Long X, Lujan-Hernandez JR, et al.: Marjolin's ulcer: A preventable malignancy arising from scars. World J Surg Oncol 2013;11:313.
43.
Abramovitch R, Marikovsky M, Meir G, Neeman M: Stimulation of tumour growth by wound-derived growth factors. Br J Cancer 1999;79:1392-1398.
44.
Coussens LM, Werb Z: Inflammation and cancer. Nature 2002;420:860-867.
45.
Pera M, Nelson H, Rajkumar SV, et al.: Influence of postoperative acute-phase response on angiogenesis and tumor growth: Open vs. laparoscopic-assisted surgery in mice. J Gastrointest Surg 2003;7:783-790.
46.
Retsky M, Demicheli R, Hrushesky WJM: Does surgery induce angiogenesis in breast cancer? Indirect evidence from relapse pattern and mammography paradox. Int J Surg 2005;3:179-187.
47.
Cho YA, Sung MK, Yeon JY, et al.: Prognostic role of interleukin-6, interleukin-8, and leptin levels according to breast cancer subtype. Cancer Res Treat 2013;45:210-219.
48.
Baigrie RJ, Lamont PM, Kwaitkowski D, et al.: Systemic cytokine response after major surgery. Br J Surg 1992;79:757-760.
49.
Harmey JH, Bucana CD, Lu W, et al.: Lipopolysaccharide-induced metastatic growth is associated with increased angiogenesis, vascular permeability and tumor cell invasion. Int J Cancer 2002;101:415-422.
50.
Xue DQ, Qian C, Yang L, Wang XF: Risk factors for surgical site infections after breast surgery: A systematic review and meta-analysis. Eur J Surg Oncol 2012;38:375-381.
51.
Pinsolle V, Grinfeder C, Mathoulin-Pelissier S, Faucher A: Complications analysis of 266 immediate breast reconstructions. J Plast Reconstr Aesthetic Surg 2006;59:1017-1024.
52.
Indelicato D, Grobmyer SR, Newlin H, et al.: Association between operative closure type and acute infection, local recurrence, and disease surveillance in patients undergoing breast conserving therapy for early-stage breast cancer. Surgery 2007;141:645-653.
53.
Bunn F, Jones DJ, Bell-Syer S: Prophylactic antibiotics to prevent surgical site infection after breast cancer surgery. Cochrane Database Syst Rev 2012;1:CD005360.
54.
Weber WP, Marti WR, Zwahlen M, et al.: The timing of surgical antimicrobial prophylaxis. Ann Surg 2008;247:918-926.
55.
Ashraf M, Biswas J, Gupta S, Alam N: Determinants of wound infections for breast procedures: Assessment of the risk of wound infection posed by an invasive procedure for subsequent operation. Int J Surg 2009;7:543-546.
56.
Kato H, Nakagami G, Iwahira Y, et al.: Risk factors and risk scoring tool for infection during tissue expansion in tissue expander and implant breast reconstruction. Breast J 2013;19:618-626.
57.
Hogan BV, Peter MB, Achuthan R, et al.: Perioperative reductions in circulating lymphocyte levels predict wound complications after excisional breast cancer surgery. Ann Surg 2011;253:360-364.
58.
Lapsley HM, Vogels R: Quality and cost impacts: Prevention of post-operative clean wound infections. Int J Health Care Qual Assur Inc Leadersh Health Serv 1998;11:222-231.
You do not currently have access to this content.