Sepsis and asepsis in large bowel cancer surgery

A patient undergoing surgery for carcinoma of the large bowel has 2 hurdles to negotiate before claiming a cure. The first is postoperative complications and the second, recurrence of the tumor. Recurrence of the tumor will occur almost always within the first 5 years. Postoperative complications are mainly related to infection. Infection on its own is rarely responsible for the death of the patient, but by damaging the vascular endothelium may predispose to arterial or venous thrombosis. More commonly, sublethal sepsis is the cause of considerable morbidity whether within the abdominal wound or the intraperitoneal cavity. One or more of 3 basically different methods are employed to control infection in large bowel surgery: (1) reduction in the number of microorganisms in the large bowel; (2) reduction in the number of microorganisms contaminating the wound, whether within or without the peritoneal cavity; and (3) destruction of microorganisms contaminating the wound. The authors have relied on reducing the number of microorganisms contaminating the wound by strict attention to wound protection and aseptic surgery, and the destruction of microorganisms that actually reach the wound. To this end, excellent results with antibiotics have been obtained by combining meticulous aseptic surgery with the use of cefazolin and metronidazole administered a short time prior to surgery.