Postoperative Infectious Complications Worsen Long-Term Survival After Curative-Intent Resection for Hepatocellular Carcinoma

• Published in: Annals of surgical oncology 2022-01, Vol.29 (1), p.315-324
• Main Authors: 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.
• Format: Article
• Language: English
• Subjects: Carcinoma, Hepatocellular - surgery; Communicable Diseases; Complications; Hepatobiliary Tumors; Hepatocellular carcinoma; Humans; Liver cancer; Liver Neoplasms - surgery; Medical prognosis; Medicine; Medicine & Public Health; Oncology; Patients; Postoperative; Postoperative period; Prognosis; Risk factors; Surgery; Surgical Oncology; Surgical Wound Infection - etiology; Survival; Tumors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10565-2

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.