Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Shirata, Chikara; Hasegawa, Kiyoshi; Kobayashi, Takashi; Arita, Junichi; Akamatsu, Nobuhisa; Kaneko, Junichi; Sakamoto, Yoshihiro; Makuuchi, Masatoshi; Kokudo, Norihiro

doi:10.1159/000477777

Cited by 23 publications

(13 citation statements)

References 28 publications

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“…Surgical site infection (SSI) is a common complication following hepatectomy and is classified as superficial SSI, deep or incisional SSI, and organ/space SSI . 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 .…”

Section: Introductionmentioning

confidence: 99%

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

Rungsakulkij

Vassanasiri

Tangtawee

et al. 2019

J Hepato Biliary Pancreat

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Background Major hepatectomy is a complex surgical procedure with high morbidity. Intra-abdominal infection (IAI) is common following hepatectomy and affects treatment outcomes. This study was performed to investigate perioperative factors and determine whether the preoperative serum albumin level is associated with IAI following major hepatectomy. Methods From January 2008 to December 2018, 268 patients underwent major hepatectomy. We retrospectively analyzed demographic data and preoperative and perioperative variables. IAI was defined as organ/space surgical site infection. Risk factors for IAI were analyzed by logistic regression analysis. Results In total, 268 patients were evaluated. IAI was observed in 38 patients (14.6%). The mortality rate in the IAI group was 15.7%. Multivariate logistic analysis confirmed that the serum albumin level (odds ratio 0.91; 95% confidence interval 0.84-0.97; P = 0.03) and operative duration (odds ratio 1.50; 95% confidence interval 1.18-1.91; P < 0.01) were independent factors associated with IAI. A logistic model using the serum albumin level and operative duration to estimate the probability of IAI was analyzed. The area under the receiver operating characteristic curve for predicting IAI was 0.78. ConclusionThe serum albumin level and operative duration were independent factors predicting IAI following major hepatectomy.

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Section: Introductionmentioning

confidence: 99%

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

Rungsakulkij

Vassanasiri

Tangtawee

et al. 2019

J Hepato Biliary Pancreat

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“…Surgical indications, preoperative treatment and surgical operations have an impact on the occurrence of bile leakage. In a retrospective analysis of 879 patients who underwent hepatectomy, Chikara et al found that bile leakage was the strongest risk factor for a postoperative organ (or lacunar) infection [ 33 ], so, bile leakage leads to poor drainage of infectious bile, which leads to cholestasis and secondary infection [ 34 ]. Therefore, the operator should strictly follow the operating procedures and handle the operation with care, and in case of accidental injury, it must be treated immediately.…”

Section: Discussionmentioning

confidence: 99%

Influencing factors and predictive model of postoperative infection in patients with primary hepatic carcinoma

Ma¹,

Teng²,

Wang³

et al. 2023

BMC Gastroenterol

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Background The purpose of this study was to explore the risk factors for postoperative infection in patients with primary hepatic carcinoma (PHC), build a nomogram prediction model, and verify the model to provide a better reference for disease prevention, diagnosis and treatment. Methods This single-center study included 555 patients who underwent hepatobiliary surgery in the Department of Hepatobiliary Surgery of Tianjin Third Central Hospital from January 2014 to December 2021, and 32 clinical indicators were selected for statistical analysis. In this study, Lasso logistic regression was used to determine the risk factors for infection after liver cancer resection, establish a predictive model, and construct a visual nomogram. The consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve were used for internal validation, and decision curve analysis (DCA) was used to analyze the clinical applicability of the predictive model. The bootstrap method was used for intramodel validation, and the C-index was calculated to assess the model discrimination. Results Among the 555 patients, 279 patients met the inclusion criteria, of whom 48 had a postoperative infection, with an incidence rate of 17.2%. Body mass index (BMI) (P = 0.022), alpha-fetoprotein (P = 0.023), total bilirubin (P = 0.016), intraoperative blood loss (P < 0.001), and bile leakage (P < 0.001) were independent risk factors for infection after liver cancer surgery. The nomogram was constructed and verified to have good discriminative and predictive ability. DCA showed that the model had good clinical applicability. The C-index value verified internally by the bootstrap method results was 0.818. Conclusion Postoperative infection in patients undergoing hepatectomy may be related to risk factors such as BMI, preoperative AFP level, TBIL level, intraoperative blood loss and bile leakage. The prediction model of the postoperative infection nomogram established in this study can better predict and estimate the risk of postoperative infection in patients undergoing hepatectomy.

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“…The infection rate of our study was 8.2%, including 6.5% of SSI and 2.0% of RI, which were close to reported results. Previous studies reported infection rate after hepatectomy as 2.1% to 34% 15,23,24 . We considered possible reasons of different infection rates in previous studies as follows: first, several studies enrolled patients with multiple diseases, including liver metastasis and hepatolithiasis.…”

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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Surgical Site Infection after Hepatectomy for Hepatocellular Carcinoma

Cited by 23 publications

References 28 publications

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

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

Influencing factors and predictive model of postoperative infection in patients with primary hepatic carcinoma

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

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