Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Yang, Tian; Liu, K.; Liu, Chenghong; Zhong, Qian; Zhang, J.; Yu, Jianwei; Liang, Lei; Li, C.; Wang, M.‐D.; Li, Zheng-chuan; Wu, Han; Xing, Hui; Han, Jun; Lau, W. Y.; Zeng, Yongyi; Zhou, Ya-Hao; Gu, Wei‐Min; Wang, H.; Chen, T.‐H.; Zhang, Y.‐M.; Zhang, Wei; Pawlik, Timothy M.; Wu, Mengchao

doi:10.1002/bjs.11231

Cited by 48 publications

(36 citation statements)

References 23 publications

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“…Indeed, it has been reported that intraoperative parameters, such as blood loss and transfusion, 12 nature of the resection, 13 and extent of the surgical margin, 14 but also postoperative complications, may play a pivotal role in recurrence. 15,16 In this setting, textbook outcome (TO), a composite measure of desirable postoperative outcomes, was recently reported to be associated with improved survival following resection for HCC, and may thus represent a relevant combination of surgical-related factors accounting for the overall quality of surgical care, which could affect prognosis. 17 The laparoscopic approach has progressively gained acceptance for the surgical management of HCC patients, and several guidelines now recommend its routine use in an increasing subset of patients with resectable HCC, especially those with early-stage lesions occurring on compensated cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

et al. 2020

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LLR vs. OLR 44 vs. 31% TO vs. No TO 33 vs. 18% Highlights Homogeneous population of 425 resected patients with early-stage HCC in cirrhosis. Textbook outcome following liver resection was achieved in 32.9% of patients. The minimal invasive approach increases the chance of achieving a textbook outcome. Textbook outcome following liver resection improves DFS and probability of cure. Minimal invasive treatments of early HCC have a promising curative effect. Lay summary The overall quality of surgical care, as measured by TO, plays a pivotal role in the prognosis and, in particular, on the probability of statistical cure of patients with resectable early-stage HCC occurring in cirrhosis. By influencing TO, laparoscopy has an indirect impact on the probability of cure and long-term management of these patients. This study strongly supports the promising curative role of mini-invasive treatments for early-stage HCC, such as low-difficulty LLR.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

et al. 2020

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“…Patients at BCLC stage B–C had heavier tumor burden and wider surgical extent. And major hepatectomy was also a risk factor of postoperative infection in HCC 34 . Our results showed that liver function and surgical extent were also common consideration of surgeons to evaluate the probability of infection.…”

Section: Discussionmentioning

confidence: 64%

“…Patients with higher ALBI score, at BCLC stage B–C, or underwent major hepatectomy tended to receive POA in our study. Liver function test results, like bilirubin and albumin, were often reported related to the incidence of infection in liver surgery 34–36 . Patients at BCLC stage B–C had heavier tumor burden and wider surgical extent.…”

Section: Discussionmentioning

confidence: 99%

Three‐day postoperative antibiotics reduces post‐hepatectomy infection rate in hepatitis B virus‐related hepatocellular carcinoma

Chen

Jiang

Wang

et al. 2021

J of Gastro and Hepatol

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Background and Aim The evidences for use of postoperative antibiotics (POA) in hepatocellular carcinoma (HCC) patients who underwent hepatectomy are controversial. We aimed to explore the relationship between POA and hepatectomy‐related infection in a hepatitis B virus (HBV)‐related HCC population. Methods We retrospectively collected 934 HCC patients who underwent hepatectomy for curative intent from three tertiary hospitals in China. The incidences of postoperative infection including surgical site infection and remote site infection were recorded and calculated. Univariable and multivariable logistic regression analyses were performed to explore related factors of postoperative infection and POA. And the relationship between infection rates with different durations of POA was investigated. Results The overall infection rate was 8.2% (77/934), including 6.5% (61/934) of surgical site infection and 2.0% (19/934) of remote site infection. Multivariable analysis revealed that the administration of POA was negatively related with the incidence of postoperative infection significantly (odds ratio = 0.50, 95% confidence interval = 0.30 to 0.83; P = 0.008). Albumin‐bilirubin score, Barcelona Clinic Liver Cancer (BCLC) stage and extent of hepatectomy were independently related to the POA. And 3‐day regimen seemed to be the shortest duration of POA to gain the lowest incidence of postoperative infection. Conclusions Postoperative antibiotic is necessary for HBV‐related HCC patients to prevent postoperative infection, especially for those with higher albumin‐bilirubin score, at BCLC stage B–C, or who underwent major hepatectomy. For HBV‐related HCC patients, postoperative second‐generation cephalosporins, or ceftriaxone for 3 days after surgery might be proper.

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“…Postoperative complications have a substantial negative impact on the postoperative course and oncological outcomes. [6][7][8][9] Previous studies have identified several risk factors for postoperative morbidity after hepatectomy for patients with HCC. [10][11][12][13][14][15] Preoperative poor nutritional and immunological status have been associated with postoperative morbidity and poor long-term outcomes of patients with malignant tumors.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Nutritional Index Considering Resection Range Is Useful for Predicting Postoperative Morbidity of Hepatectomy

Nagata

Maeda

Nagamatsu

et al. 2021

Journal of Gastrointestinal Surgery

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Background Poor preoperative nutritional and immunological status are major risk factors for postoperative complications in patients with various malignancies. Lower preoperative prognostic nutrition index (PNI) is associated with higher rates of postoperative complications and poorer prognosis in those patients. The aim of this study was to analyze the predictive value of the PNI for post-hepatectomy complications in patients with hepatocellular carcinoma (HCC), and evaluate its utility in the surgical procedure. Methods This retrospective study included 510 patients who underwent open hepatectomies for HCC. The predictive value of the preoperative nutritional and immunological status for postoperative complications was assessed using the PNI. Postoperative complications were defined as grade II or higher per the Clavien-Dindo classification. Postoperative complication rates were compared according to surgical procedure (major hepatectomy vs minor hepatectomy). Results Patients with postoperative complications had significantly lower PNIs than those without (43.1 ± 5.5 vs 47.0 ± 5.7, P < 0.001). In the multivariate analysis, low preoperative PNI (< 45) was an independent risk factor for postoperative complications after hepatectomy (hazard ratio, 3.85). When patients were classified per their PNI (high vs low) and extent of surgical procedures (major vs minor), there were more complications among patients with low PNI than those with high PNI, regardless of the extent of surgical procedures. Specifically, the group of patients with low PNI who underwent major hepatectomy had significantly higher rates of postoperative complications than the other groups. Conclusions Adding the resection range to the PNI is useful for predicting the postoperative morbidities of hepatectomy patients.

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Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Cited by 48 publications

References 23 publications

Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

Influence of surgical approach and quality of resection on the probability of cure for early-stage HCC occurring in cirrhosis

Three‐day postoperative antibiotics reduces post‐hepatectomy infection rate in hepatitis B virus‐related hepatocellular carcinoma

Prognostic Nutritional Index Considering Resection Range Is Useful for Predicting Postoperative Morbidity of Hepatectomy

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