{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:52:46Z","timestamp":1781632366018,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Carl Gustav Carus Dresden an der Technischen Universit\u00e4t Dresden"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Langenbecks Arch Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Infectious complications remain a significant cause of morbidity after gastrectomy for gastric cancer. Selective decontamination of the digestive tract (SDD) is effective in colorectal surgery, but its role in upper gastrointestinal procedures is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients undergoing open gastrectomy between 2014 and 2024. Patients treated with perioperative SDD (2018\u20132024) were compared with a matched historical cohort without SDD (2014\u20132018) using 1:1 propensity score matching (PSM). The primary endpoint was infectious complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 108 patients were matched (54 SDD, 54 non-SDD). Rates of major complications (16.7% vs. 14.8%), anastomotic leakage (5.6% vs. 3.7%), superficial surgical site infections (SSIs) (14.8% vs. 11.1%), and organ\/space infections (7.4% vs. 13.0%) were similar between the two groups. However, pneumonia occurred significantly more frequently in the SDD group (18.5% vs. 3.7%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). Microbiological analyses revealed more enterobacteriaceae and enterococci in the SDD group, with resistant isolates detected exclusively in this cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SDD did not reduce infectious complications after gastrectomy and was associated with higher pneumonia rates and the emergence of resistant isolates. These findings question its routine use in gastric cancer surgery and highlight the need for further prospective evaluation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00423-026-03974-y","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T21:25:39Z","timestamp":1769117139000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perioperative selective decontamination of the digestive tract does not improve postoperative infectious complications after gastrectomy: a propensity score-matched analysis"],"prefix":"10.1007","volume":"411","author":[{"given":"Jasmin","family":"Hasanovic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris","family":"Berg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Teske","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Distler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Weitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Stange","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Merboth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"3974_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","volume":"71","author":"H Sung","year":"2021","unstructured":"Sung H, Ferlay J, Siegel RL et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality. CA Cancer J Clin 71:209\u2013249. https:\/\/doi.org\/10.3322\/caac.21660","journal-title":"CA Cancer J Clin"},{"key":"3974_CR2","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/S0140-6736(20)31288-5","volume":"396","author":"EC Smyth","year":"2020","unstructured":"Smyth EC, Nilsson M, Grabsch HI, van Grieken NCT, Lordick F (2020) Gastric cancer. Lancet 396:635\u2013648. https:\/\/doi.org\/10.1016\/S0140-6736(20)31288-5","journal-title":"Lancet"},{"key":"3974_CR3","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s12957-019-1593-9","volume":"17","author":"S Wang","year":"2019","unstructured":"Wang S, Xu L, Wang Q et al (2019) Postoperative complications and prognosis after radical gastrectomy for gastric cancer: a systematic review and meta-analysis. World J Surg Oncol 17:52. https:\/\/doi.org\/10.1186\/s12957-019-1593-9","journal-title":"World J Surg Oncol"},{"key":"3974_CR4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1245\/s10434-008-0249-8","volume":"16","author":"H Tsujimoto","year":"2009","unstructured":"Tsujimoto H, Ichikura T, Ono S et al (2009) Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16:311\u2013318. https:\/\/doi.org\/10.1245\/s10434-008-0249-8","journal-title":"Ann Surg Oncol"},{"key":"3974_CR5","doi-asserted-by":"publisher","first-page":"1144","DOI":"10.1016\/j.ejso.2013.06.021","volume":"39","author":"J Yu","year":"2013","unstructured":"Yu J, Hu J, Huang C et al (2013) Impact of age and comorbidity on postoperative complications in patients with advanced gastric cancer after laparoscopic D2 gastrectomy. Eur J Surg Oncol 39:1144\u20131149. https:\/\/doi.org\/10.1016\/j.ejso.2013.06.021","journal-title":"Eur J Surg Oncol"},{"key":"3974_CR6","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1089\/sur.2013.031","volume":"15","author":"M Inokuchi","year":"2014","unstructured":"Inokuchi M, Kojima K, Kato K, Sugita H, Sugihara K (2014) Risk factors for postoperative pulmonary complications after gastrectomy for gastric cancer. Surg Infect (Larchmt) 15:314\u2013321. https:\/\/doi.org\/10.1089\/sur.2013.031","journal-title":"Surg Infect (Larchmt)"},{"key":"3974_CR7","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1002\/bjs.4952","volume":"92","author":"DJ Park","year":"2005","unstructured":"Park DJ, Lee HJ, Kim HH et al (2005) Predictors of operative morbidity and mortality in gastric cancer surgery. Br J Surg 92:1099\u20131102. https:\/\/doi.org\/10.1002\/bjs.4952","journal-title":"Br J Surg"},{"key":"3974_CR8","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1007\/s10120-020-01102-3","volume":"24","author":"M Tokunaga","year":"2021","unstructured":"Tokunaga M, Kurokawa Y, Machida R et al (2021) Impact of postoperative complications on survival outcomes in patients with gastric cancer: exploratory analysis of a randomized controlled JCOG1001 trial. Gastric Cancer 24:214\u2013223. https:\/\/doi.org\/10.1007\/s10120-020-01102-3","journal-title":"Gastric Cancer"},{"key":"3974_CR9","doi-asserted-by":"publisher","first-page":"587309","DOI":"10.3389\/fonc.2021.587309","volume":"11","author":"HY Pang","year":"2021","unstructured":"Pang HY, Zhao LY, Wang H et al (2021) Impact of type of postoperative complications on long-term survival of gastric cancer patients: results from a high-volume institution in China. Front Oncol 11:587309. https:\/\/doi.org\/10.3389\/fonc.2021.587309","journal-title":"Front Oncol"},{"key":"3974_CR10","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1186\/s12885-019-6024-3","volume":"19","author":"P Yuan","year":"2019","unstructured":"Yuan P, Wu Z, Li Z et al (2019) Impact of postoperative major complications on long-term survival after radical resection of gastric cancer. BMC Cancer 19:833. https:\/\/doi.org\/10.1186\/s12885-019-6024-3","journal-title":"BMC Cancer"},{"key":"3974_CR11","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1007\/s00595-015-1201-8","volume":"46","author":"Y Miki","year":"2016","unstructured":"Miki Y, Makuuchi R, Tokunaga M et al (2016) Risk factors for postoperative pneumonia after gastrectomy for gastric cancer. Surg Today 46:552\u2013556. https:\/\/doi.org\/10.1007\/s00595-015-1201-8","journal-title":"Surg Today"},{"key":"3974_CR12","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s00268-021-06352-5","volume":"46","author":"K Eto","year":"2022","unstructured":"Eto K, Yoshida N, Iwatsuki M et al (2022) Impact of type of gastrectomy on death from pneumonia Inelderly gastric cancer patients. World J Surg 46:425\u2013432. https:\/\/doi.org\/10.1007\/s00268-021-06352-5","journal-title":"World J Surg"},{"key":"3974_CR13","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s00595-018-1726-8","volume":"49","author":"R Makuuchi","year":"2019","unstructured":"Makuuchi R, Irino T, Tanizawa Y, Bando E, Kawamura T, Terashima M (2019) Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer. Surg Today 49:187\u2013196. https:\/\/doi.org\/10.1007\/s00595-018-1726-8","journal-title":"Surg Today"},{"key":"3974_CR14","doi-asserted-by":"publisher","first-page":"5022","DOI":"10.3390\/jcm11175022","volume":"11","author":"U Bracale","year":"2022","unstructured":"Bracale U, Peltrini R, De Luca M et al (2022) Predictive factors for anastomotic leakage after laparoscopic and open total gastrectomy: a systematic review. J Clin Med 11:5022. https:\/\/doi.org\/10.3390\/jcm11175022","journal-title":"J Clin Med"},{"key":"3974_CR15","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.1002\/bjs.10405","volume":"104","author":"JC Alverdy","year":"2017","unstructured":"Alverdy JC, Hyoju SK, Weigerinck M, Gilbert JA (2017) The gut Microbiome and the mechanism of surgical infection. Br J Surg 104:e14\u2013e23. https:\/\/doi.org\/10.1002\/bjs.10405","journal-title":"Br J Surg"},{"key":"3974_CR16","doi-asserted-by":"publisher","first-page":"874223","DOI":"10.3389\/fsurg.2022.874223","volume":"9","author":"J Schardey","year":"2022","unstructured":"Schardey J, von Ahnen T, Schardey E et al (2022) Antibiotic bowel decontamination in Gastrointestinal surgery: a single-center 20 years\u2019 experience. Front Surg 9:874223. https:\/\/doi.org\/10.3389\/fsurg.2022.874223","journal-title":"Front Surg"},{"key":"3974_CR17","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12866-019-1399-5","volume":"19","author":"FCF Schmitt","year":"2019","unstructured":"Schmitt FCF, Brenner T, Uhle F et al (2019) Gut Microbiome patterns correlate with higher postoperative complication rates after pancreatic surgery. BMC Microbiol 19:42. https:\/\/doi.org\/10.1186\/s12866-019-1399-5","journal-title":"BMC Microbiol"},{"key":"3974_CR18","doi-asserted-by":"publisher","first-page":"2441","DOI":"10.1007\/s00423-022-02540-6","volume":"407","author":"A Bogner","year":"2022","unstructured":"Bogner A, Stracke M, Bork U et al (2022) Selective decontamination of the digestive tract in colorectal surgery reduces anastomotic leakage and costs: a propensity score analysis. Langenbecks Arch Surg 407:2441\u20132452. https:\/\/doi.org\/10.1007\/s00423-022-02540-6","journal-title":"Langenbecks Arch Surg"},{"key":"3974_CR19","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1002\/bjs5.50332","volume":"4","author":"F Scheufele","year":"2020","unstructured":"Scheufele F, Schirren R, Friess H, Reim D (2020) Selective decontamination of the digestive tract in upper Gastrointestinal surgery: systematic review with meta-analysis. BJS Open 4:932\u2013942. https:\/\/doi.org\/10.1002\/bjs5.50332","journal-title":"BJS Open"},{"key":"3974_CR20","doi-asserted-by":"publisher","first-page":"250","DOI":"10.3390\/jcm12010250","volume":"12","author":"O Radulova-Mauersberger","year":"2022","unstructured":"Radulova-Mauersberger O, Oehme F, Doerell A et al (2022) Selective decontamination of the digestive tract in pancreatic head resections: a propensity score-matched analysis. J Clin Med 12:250. https:\/\/doi.org\/10.3390\/jcm12010250","journal-title":"J Clin Med"},{"key":"3974_CR21","doi-asserted-by":"publisher","first-page":"1844","DOI":"10.1016\/j.gassur.2024.08.030","volume":"28","author":"N Mibelli","year":"2024","unstructured":"Mibelli N, Oehme F, Radulova-Mauersberger O et al (2024) Bacterial shift and resistance pattern in pancreatic head resections after selective decontamination. J Gastrointest Surg 28:1844\u20131852. https:\/\/doi.org\/10.1016\/j.gassur.2024.08.030","journal-title":"J Gastrointest Surg"},{"key":"3974_CR22","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1136\/ejhpharm-2016-000931","volume":"24","author":"C Pfeifer","year":"2017","unstructured":"Pfeifer C, Noll S, Gerecke H et al (2017) A stability study of amphotericin B, colistin and tobramycin in a hydrophilic suspension. Eur J Hosp Pharm 24:235\u2013241. https:\/\/doi.org\/10.1136\/ejhpharm-2016-000931","journal-title":"Eur J Hosp Pharm"},{"key":"3974_CR23","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1002\/bjs.9582","volume":"101","author":"K Mortensen","year":"2014","unstructured":"Mortensen K, Nilsson M, Slim K et al (2014) Consensus guidelines for enhanced recovery after gastrectomy: enhanced recovery after surgery (ERAS\u00ae) society recommendations. Br J Surg 101:1209\u20131229. https:\/\/doi.org\/10.1002\/bjs.9582","journal-title":"Br J Surg"},{"key":"3974_CR24","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205\u2013213. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"key":"3974_CR25","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.1093\/cid\/ciw353","volume":"63","author":"AC Kalil","year":"2016","unstructured":"Kalil AC, Metersky ML, Klompas M et al (2016) Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines. Clin Infect Dis 63:e61\u2013e111. https:\/\/doi.org\/10.1093\/cid\/ciw353","journal-title":"Clin Infect Dis"},{"key":"3974_CR26","doi-asserted-by":"publisher","first-page":"1512","DOI":"10.1038\/s41467-017-01803-x","volume":"8","author":"RL Brown","year":"2017","unstructured":"Brown RL, Sequeira RP, Clarke TB (2017) The microbiota protects against respiratory infection via M-CSF signaling. Nat Commun 8:1512. https:\/\/doi.org\/10.1038\/s41467-017-01803-x","journal-title":"Nat Commun"},{"key":"3974_CR27","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1186\/s12885-025-14149-1","volume":"25","author":"S Fan","year":"2025","unstructured":"Fan S, Jiang H, Xu Q et al (2025) Risk factors for pneumonia after radical gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Cancer 25:840. https:\/\/doi.org\/10.1186\/s12885-025-14149-1","journal-title":"BMC Cancer"},{"key":"3974_CR28","doi-asserted-by":"publisher","first-page":"107116","DOI":"10.1016\/j.ejso.2023.107116","volume":"49","author":"JRD Reuvers","year":"2023","unstructured":"Reuvers JRD, Gaikhorst E, Ben \u00c2J et al (2023) Cost-effectiveness of selective decontamination of the digestive tract to decrease infectious complications in colorectal cancer surgery. Eur J Surg Oncol 49:107116. https:\/\/doi.org\/10.1016\/j.ejso.2023.107116","journal-title":"Eur J Surg Oncol"},{"key":"3974_CR29","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1097\/SLA.0000000000001125","volume":"261","author":"MS Morris","year":"2015","unstructured":"Morris MS, Graham LA, Chu DI et al (2015) Oral antibiotic bowel Preparation significantly reduces surgical site infection rates and readmission in elective colorectal surgery. Ann Surg 261:1034\u20131040. https:\/\/doi.org\/10.1097\/SLA.0000000000001125","journal-title":"Ann Surg"},{"key":"3974_CR30","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1007\/BF01708581","volume":"18","author":"H Humphreys","year":"1992","unstructured":"Humphreys H, Winter R, Pick A (1992) The effect of selective decontamination of the digestive tract on Gastrointestinal enterococcal colonization in ITU patients. Intensive Care Med 18:459\u2013463. https:\/\/doi.org\/10.1007\/BF01708581","journal-title":"Intensive Care Med"},{"key":"3974_CR31","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1093\/jac\/dku092","volume":"69","author":"E Buelow","year":"2014","unstructured":"Buelow E, Gonzalez TB, Versluis D et al (2014) Effects of selective digestive decontamination (SDD) on the gut resistome. J Antimicrob Chemother 69:2215\u20132223. https:\/\/doi.org\/10.1093\/jac\/dku092","journal-title":"J Antimicrob Chemother"},{"key":"3974_CR32","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1164\/rccm.200908-1210OC","volume":"181","author":"EA Oostdijk","year":"2010","unstructured":"Oostdijk EA, de Smet AM, Blok HE et al (2010) Ecological effects of selective decontamination on resistant gram-negative bacterial colonization. Am J Respir Crit Care Med 181:452\u2013457. https:\/\/doi.org\/10.1164\/rccm.200908-1210OC","journal-title":"Am J Respir Crit Care Med"}],"updated-by":[{"DOI":"10.1007\/s00423-026-03991-x","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T00:00:00Z","timestamp":1770422400000}}],"container-title":["Langenbeck's Archives of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00423-026-03974-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-03974-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00423-026-03974-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:58:53Z","timestamp":1781629133000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00423-026-03974-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,22]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3974"],"URL":"https:\/\/doi.org\/10.1007\/s00423-026-03974-y","relation":{},"ISSN":["1435-2451"],"issn-type":[{"value":"1435-2451","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,22]]},"assertion":[{"value":"16 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 February 2026","order":6,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":7,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The original online version of this article was revised: The author's name, 'Jasmin Hasanovic,' appeared as both the first and last author. 'Jasmin Hasanovic' should be listed as the first author, and 'Felix Merboth' should be listed as the last author.","order":8,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2026","order":9,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Correction","order":10,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"A Correction to this paper has been published:","order":11,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"https:\/\/doi.org\/10.1007\/s00423-026-03991-x","URL":"https:\/\/doi.org\/10.1007\/s00423-026-03991-x","order":12,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The study protocol was approved by the institutional review board (BO-EK-379082025), and all procedures were conducted in compliance with the ethical standards of the Declaration of Helsinki. A waiver was granted for informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable; the manuscript contains no identifiable personal data or images of individual participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Consent to publish"}}],"article-number":"73"}}