Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Department of Anaesthesiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Br J Surg. 2019 Aug;106(9):1228-1236. doi: 10.1002/bjs.11231. Epub 2019 Jul 5.
Postoperative complications have a great impact on the postoperative course and oncological outcomes following major cancer surgery. Among them, infective complications play an important role. The aim of this study was to evaluate whether postoperative infective complications influence long-term survival after liver resection for hepatocellular carcinoma (HCC).
Patients who underwent resection with curative intent for HCC between July 2003 and June 2016 were identified from a multicentre database (8 institutions) and analysed retrospectively. Independent risk factors for postoperative infective complications were identified. After excluding patients who died 90 days or less after surgery, overall survival (OS) and recurrence-free survival (RFS) were compared between patients with and without postoperative infective complications within 30 days after resection.
Among 2442 patients identified, 332 (13·6 per cent) had postoperative infective complications. Age over 60 years, diabetes mellitus, obesity, cirrhosis, intraoperative blood transfusion, duration of surgery exceeding 180 min and major hepatectomy were identified as independent risk factors for postoperative infective complications. Univariable analysis revealed that median OS and RFS were poorer among patients with postoperative infective complications than among patients without (54·3 versus 86·8 months, and 22·6 versus 43·2 months, respectively; both P < 0·001). After adjustment for other prognostic factors, multivariable Cox regression analyses identified postoperative infective complications as independently associated with decreased OS (hazard ratio (HR) 1·20, 95 per cent c.i. 1·02 to 1·41; P = 0·027) and RFS (HR 1·19, 1·03 to 1·37; P = 0·021).
Postoperative infective complications decreased long-term OS and RFS in patients treated with liver resection for HCC.
术后并发症对重大癌症手术后的术后过程和肿瘤学结果有重大影响。其中，感染性并发症起着重要作用。本研究旨在评估肝癌（HCC）肝切除术后感染性并发症是否影响长期生存。
从一个多中心数据库（8 家机构）中确定了 2003 年 7 月至 2016 年 6 月期间接受根治性切除术治疗 HCC 的患者，并进行回顾性分析。确定术后感染性并发症的独立危险因素。排除术后 90 天内死亡的患者后，比较术后 30 天内有无术后感染性并发症患者的总生存（OS）和无复发生存（RFS）。
在确定的 2442 名患者中，有 332 名（13.6%）发生术后感染性并发症。年龄>60 岁、糖尿病、肥胖、肝硬化、术中输血、手术时间超过 180 分钟和广泛肝切除术是术后感染性并发症的独立危险因素。单变量分析显示，与无术后感染性并发症的患者相比，术后感染性并发症患者的中位 OS 和 RFS 更差（分别为 54.3 个月与 86.8 个月和 22.6 个月与 43.2 个月；均 P<0.001）。在调整其他预后因素后，多变量 Cox 回归分析确定术后感染性并发症与降低 OS（风险比（HR）1.20，95%置信区间 1.02 至 1.41；P=0.027）和 RFS（HR 1.19，1.03 至 1.37；P=0.021）独立相关。
肝癌肝切除术后感染性并发症降低了患者的长期 OS 和 RFS。
