Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma

Tao Wei; Xu-Feng Zhang; Fabio Bagante; Francesca Ratti; Hugo P. Marques; Silvia Silva; Olivier Soubrane; Vincent Lam; George A. Poultsides; Irinel Popescu; Razvan Grigorie; Sorin Alexandrescu; Guillaume Martel; Aklile Workneh; Alfredo Guglielmi; Tom Hugh; Luca Aldrighetti; Itaru Endo; Timothy M. Pawlik

doi:10.1245/s10434-021-10565-2

Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma

Tao Wei, Xu-Feng Zhang, Fabio Bagante, Francesca Ratti, Hugo P. Marques, Silvia Silva, Olivier Soubrane, Vincent Lam, George A. Poultsides, Irinel Popescu, Razvan Grigorie, Sorin Alexandrescu, Guillaume Martel, Aklile Workneh, Alfredo Guglielmi, Tom Hugh, Luca Aldrighetti, Itaru Endo, Timothy M. Pawlik^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

18 Citations (Scopus)

Abstract

Background. 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). Methods. 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. Results. 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]). Conclusion. 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.

Original language	English
Pages (from-to)	315-324
Number of pages	10
Journal	Annals of Surgical Oncology
Volume	29
Issue number	1
Early online date	10 Aug 2021
DOIs	https://doi.org/10.1245/s10434-021-10565-2
Publication status	Published - 1 Jan 2022
Externally published	Yes

Keywords

Hepatocellular
Resection
Infection
Complications
Outcomes

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10.1245/s10434-021-10565-2

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Wei, T., Zhang, X.-F., Bagante, F., Ratti, F., Marques, H. P., Silva, S., Soubrane, O., Lam, V., Poultsides, G. A., Popescu, I., Grigorie, R., Alexandrescu, S., Martel, G., Workneh, A., Guglielmi, A., Hugh, T., Aldrighetti, L., Endo, I., & Pawlik, T. M. (2022). Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma. Annals of Surgical Oncology, 29(1), 315-324. https://doi.org/10.1245/s10434-021-10565-2

@article{92597b8f58ef4571992a85ff6fbea451,

title = "Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma",

abstract = "Background. 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). Methods. 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. Results. 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]). Conclusion. 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.",

keywords = "Hepatocellular, Resection, Infection, Complications, Outcomes",

author = "Tao Wei and Xu-Feng Zhang and Fabio Bagante and Francesca Ratti and Marques, {Hugo P.} and Silvia Silva and Olivier Soubrane and Vincent Lam and Poultsides, {George A.} and Irinel Popescu and Razvan Grigorie and Sorin Alexandrescu and Guillaume Martel and Aklile Workneh and Alfredo Guglielmi and Tom Hugh and Luca Aldrighetti and Itaru Endo and Pawlik, {Timothy M.}",

year = "2022",

month = jan,

day = "1",

doi = "10.1245/s10434-021-10565-2",

language = "English",

volume = "29",

pages = "315--324",

journal = "Annals of Surgical Oncology",

issn = "1068-9265",

publisher = "Springer, Springer Nature",

number = "1",

}

Wei, T, Zhang, X-F, Bagante, F, Ratti, F, Marques, HP, Silva, S, Soubrane, O, Lam, V, Poultsides, GA, Popescu, I, Grigorie, R, Alexandrescu, S, Martel, G, Workneh, A, Guglielmi, A, Hugh, T, Aldrighetti, L, Endo, I & Pawlik, TM 2022, 'Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma', Annals of Surgical Oncology, vol. 29, no. 1, pp. 315-324. https://doi.org/10.1245/s10434-021-10565-2

TY - JOUR

T1 - Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma

AU - Wei, Tao

AU - Zhang, Xu-Feng

AU - Bagante, Fabio

AU - Ratti, Francesca

AU - Marques, Hugo P.

AU - Silva, Silvia

AU - Soubrane, Olivier

AU - Lam, Vincent

AU - Poultsides, George A.

AU - Popescu, Irinel

AU - Grigorie, Razvan

AU - Alexandrescu, Sorin

AU - Martel, Guillaume

AU - Workneh, Aklile

AU - Guglielmi, Alfredo

AU - Hugh, Tom

AU - Aldrighetti, Luca

AU - Endo, Itaru

AU - Pawlik, Timothy M.

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Background. 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). Methods. 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. Results. 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]). Conclusion. 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.

AB - Background. 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). Methods. 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. Results. 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]). Conclusion. 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.

KW - Hepatocellular

KW - Resection

KW - Infection

KW - Complications

KW - Outcomes

UR - http://www.scopus.com/inward/record.url?scp=85112216789&partnerID=8YFLogxK

U2 - 10.1245/s10434-021-10565-2

DO - 10.1245/s10434-021-10565-2

M3 - Article

C2 - 34378089

SN - 1068-9265

VL - 29

SP - 315

EP - 324

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

IS - 1

ER -

Postoperative infectious complications worsen long-term survival after curative-intent resection for hepatocellular carcinoma

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Keywords

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