Wei Tao, Zhang Xu-Feng, Bagante Fabio, Ratti Francesca, Marques Hugo P, Silva Silvia, Soubrane Olivier, Lam Vincent, Poultsides George A, Popescu Irinel, Grigorie Razvan, Alexandrescu Sorin, Martel Guillaume, Workneh Aklile, Guglielmi Alfredo, Hugh Tom, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Ann Surg Oncol. 2022 Jan;29(1):315-324. doi: 10.1245/s10434-021-10565-2. Epub 2021 Aug 10.
Postoperative infectious complications may be associated with a worse long-term prognosis for patients undergoing surgery for a malignant indication. The current study aimed to characterize the impact of postoperative infectious complications on long-term oncologic outcomes among patients undergoing resection for hepatocellular carcinoma (HCC).
Patients who underwent curative-intent resection for HCC between 2000 and 2017 were identified from an international multi-institutional database. The relationship between postoperative infectious complications, overall survival (OS), and recurrence-free survival (RFS) was analyzed.
Among 734 patients who underwent HCC resection, 269 (36.6%) experienced a postoperative complication (Clavien-Dindo grade 1 or 2 [n = 197, 73.2%] vs grade 3 and 4 [n = 69, 25.7%]). An infectious complication was noted in 81 patients (11.0%) and 188 patients (25.6%) had non-infectious complications. The patients with infectious complications had worse OS (median: infectious complications [46.5 months] vs no complications [106.4 months] [p < 0.001] and non-infectious complications [85.7 months] [p < 0.05]) and RFS (median: infectious complications [22.1 months] vs no complications [45.5 months] [p < 0.05] and non-infectious complications [38.3 months] [p = 0.139]) than the patients who had no complication or non-infectious complications. In the multivariable analysis, infectious complications remained an independent risk factor for OS (hazard ratio [HR], 1.7; p = 0.016) and RFS (HR, 1.6; p = 0.013). Among the patients with infectious complications, patients with non-surgical-site infection (SSI) had even worse OS and RFS than patients with SSI (median OS: 19.5 vs 70.9 months [p = 0.010]; median RFS: 12.8 vs 33.9 months [p = 0.033]).
Infectious complications were independently associated with an increased long-term risk of tumor recurrence and death. Patients with non-SSI versus SSI had a particularly worse oncologic outcome.
术后感染性并发症可能与接受恶性肿瘤手术患者的长期预后较差有关。本研究旨在描述术后感染性并发症对接受肝细胞癌（HCC）切除术患者长期肿瘤学结局的影响。
从一个国际多机构数据库中识别出2000年至2017年间接受HCC根治性切除术的患者。分析术后感染性并发症、总生存期（OS）和无复发生存期（RFS）之间的关系。
在734例行HCC切除术的患者中，269例（36.6%）发生了术后并发症（Clavien-Dindo 1或2级[n = 197，73.2%]与3级和4级[n = 69，25.7%]）。81例患者（11.0%）出现感染性并发症，188例患者（25.6%）出现非感染性并发症。与无并发症或非感染性并发症的患者相比，发生感染性并发症的患者OS更差（中位数：感染性并发症[46.5个月]对比无并发症[106.4个月][p < 0.001]和非感染性并发症[85.7个月][p < 0.05]），RFS也更差（中位数：感染性并发症[22.1个月]对比无并发症[45.5个月][p < 0.05]和非感染性并发症[38.3个月][p = 0.139]）。在多变量分析中，感染性并发症仍然是OS（风险比[HR]，1.7；p = 0.016）和RFS（HR，1.6；p = 0.013）的独立危险因素。在发生感染性并发症的患者中，非手术部位感染（SSI）患者的OS和RFS比SSI患者更差（OS中位数：19.5对比70.9个月[p = 0.010]；RFS中位数：12.8对比33.9个月[p = 0.033]）。
感染性并发症与肿瘤复发和死亡的长期风险增加独立相关。非SSI患者与SSI患者相比，肿瘤学结局尤其更差。
