Risk factors and long-term outcome for postoperative intra-abdominal infection after hepatectomy for hepatocellular carcinoma

Abstract

Intra-abdominal infection (IAI) after hepatectomy is an important morbidity. Identification of risk factors that could be avoided in the perioperative period may reduce the prevalence of IAI after hepatectomy for hepatocelluar carcinoma (HCC).Between January 1995 and December 2009, all patients with HCC who underwent curative liver resection were evaluated retrospectively. Long-term outcomes were compared in IAI patients and non-IAI patients after hepatectomy. Preoperative, intraoperative, and tumor-related factors that could be independent factors for postoperative IAI were identified.Of 622 patients with HCC, 24 patients (3.9%) had IAI after hepatectomy. Both median survival and survival of patients with postoperative IAI were shorter than those for non-IAI patients (P < .05). Upon univariate analysis followed by multivariate analyses, three independent predictors for IAI were identified: weight loss (odds ratio [OR], 3.27; 95% confidence interval [CI], 1.17–9.11; P = .024), liver cirrhosis (0.28, 0.12–0.67, .004), and operative time >300 minutes (3.44, 1.46–8.12, .005).IAI after hepatectomy affects outcome adversely. Preoperative weight loss, liver cirrhosis, and operative time >300 minutes are independent predictors of postoperative IAI.

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

“…Of note, previous studies investigating infections following hepatic resection did not exclude patients who died within 90 days after surgery; such deaths were more likely to be associated with postoperative complications. After exclusion of these patients, univariable and multivariable Cox regression analyses were performed to identify the relationship between postoperative infective complications and long‐term oncological outcomes after HCC resection.…”

“…Among complications after surgery, infective complications are among the most common and are associated with worse long‐term oncological outcomes after major surgery for oesophageal, gastric, lung, head and neck, colorectal and metastatic colorectal cancers. The effect of postoperative infective complications on long‐term outcomes following liver resection for HCC has not been well defined. Furthermore, most previous studies were carried out at a single centre, had a limited sample size, performed only univariable survival analyses, focused only on intra‐abdominal infections, or evaluated only early‐stage HCC 17 .…”

“…In addition, previous studies did not exclude early postoperative deaths (90 days or less after surgery) from the survival analyses. This may have influenced the ability to assess the impact of infective complications on long‐term oncological outcomes. The objective of the present study was to evaluate whether postoperative infective complications influence oncological outcomes among patients with HCC undergoing liver resection.…”

“…The effect of postoperative infective complications on long-term outcomes following liver resection for HCC has not been well defined 16 -19 . Furthermore, most previous studies were carried out at a single centre 16,18,19 , had a limited sample size 16,18,19 , performed only univariable survival analyses 16,19 , focused only on intra-abdominal infections 18,19 , or evaluated only early-stage HCC 17 . In addition, previous studies did not exclude early postoperative deaths (90 days or less after surgery) from the survival analyses.…”

Preoperative serum albumin is associated with intra‐abdominal infection following major hepatectomy

“…Organ/space SSI and intra‐abdominal infection (IAI) are lethal complications following hepatectomy, and previous studies have shown that the incidence of IAI following hepatectomy may reach 17% . IAI is associated with poor long‐term outcomes in patients with both primary and secondary malignancies following hepatectomy . Various preoperative and perioperative factors are associated with IAI following hepatectomy.…”