• Silvia Salvans, Xavier Mayol, Sandra Alonso, Ramon Messeguer, Marta Pascual, Sergi Mojal, Luis Grande, and Miguel Pera.
• *Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar, Barcelona, Spain †Colorectal Cancer Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain ‡Biomed Division, Leitat Technological Center, Barcelona, Spain §Consulting Service on Methodology for Biomedical Research, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
• Ann. Surg.. 2014 Nov 1;260(5):939-43; discussion 943-4.

ObjectiveThe aim of this study was to investigate the effect of postoperative peritoneal infection on proliferation, migration, and invasion capacities of cancer cells lines in vitro after surgery for colorectal cancer.BackgroundAnastomotic leakage is associated with higher rates of recurrence after surgery for colorectal cancer. However, the mechanisms responsible are unknown. We hypothesized that the infection-induced inflammatory response may enhance tumor progression features of residual cancer cells.MethodsProspective matched cohort study. Patients undergoing surgery for colorectal cancer with curative intent (January 2008-March 2012) were included. Patients who had an anastomotic leak or intra-abdominal abscess were included in the infection group (n=47). For each case patient, another patient with an uncomplicated postoperative course was selected for the control group (n=47).In vitro treatments on cancer cell lines (MDA-MB-231 and SW620) were performed using baseline and postoperative serum and peritoneal fluid samples to determine cell proliferation and cell migration/invasion activities.ResultsPostoperative peritoneal fluid from infected patients enhanced both cell migration (infection: 140±85 vs control: 94±30; P=0.016) and cell invasion (infection: 117±31 vs control: 103±16; P=0.024) capacities of cancer cell lines. With serum samples, these effects were only observed in cell migration assays (infection: 98±28 vs control: 87±17; P=0.005). Some minor activation of cell proliferation was observed by treatment with serum from infection group. Two-year cumulative disease-free survival was significantly lower in patients with postoperative peritoneal infection (infection: 77.6% vs control: 90.6%; P=0.032).ConclusionsOur results suggest that postoperative peritoneal infection enhances the invasive capacity of residual tumor cells after surgery, thus facilitating their growth to recurrent tumors.

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