Prognostic impact of complications after resection of early stage hepatocellular carcinoma

Margonis, Georgios Antonios; Sasaki, Kazunari; Andreatos, Nikolaos; Nishioka, Yujiro; Sugawara, Toshitaka; Amini, Neda; Buettner, Stefan; Hashimoto, Masaji; Shindoh, Junichi; Pawlik, Timothy M.

doi:10.1002/jso.24576

Cited by 61 publications

(42 citation statements)

References 45 publications

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“…Among complications after surgery, infective complications are among the most common and are associated with worse long‐term oncological outcomes after major surgery for oesophageal, gastric, lung, head and neck, colorectal and metastatic colorectal cancers. The effect of postoperative infective complications on long‐term outcomes following liver resection for HCC has not been well defined. Furthermore, most previous studies were carried out at a single centre, had a limited sample size, performed only univariable survival analyses, focused only on intra‐abdominal infections, or evaluated only early‐stage HCC 17 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition, previous studies did not exclude early postoperative deaths (90 days or less after surgery) from the survival analyses. This may have influenced the ability to assess the impact of infective complications on long‐term oncological outcomes. The objective of the present study was to evaluate whether postoperative infective complications influence oncological outcomes among patients with HCC undergoing liver resection.…”

Section: Introductionmentioning

confidence: 99%

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Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Yang

Liu

et al. 2019

British Journal of Surgery

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Background 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). Methods 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. Results 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). Conclusion Postoperative infective complications decreased long‐term OS and RFS in patients treated with liver resection for HCC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Yang

Liu

et al. 2019

British Journal of Surgery

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“…[18, 19] While the impact of post-operative complications on long-term survival has been examined for other gastrointestinal and hepatic malignancies, the effect of complications on prognosis following resection of EHBM has not been reported. [14–17] In addition, the specific prognostic impact of SSI, one of the most common post-operative complications, has not been reported among patients with EHBM. The current study was important because we investigated the impact of SSI on RFS among a large, multi-center cohort of patients who underwent curative-intent resection for EHBM.…”

Section: Discussionmentioning

confidence: 99%

“…[14–17] Most EHBM require a major surgical procedure, which can involve a liver resection, removal of the extrahepatic biliary tree, or a pancreatoduodenectomy. [1] Peri-operative outcomes following these extensive operations can be associated with considerable morbidity, with post-operative complications as high as 30–40% in many centers.…”

Section: Introductionmentioning

confidence: 99%

“…[20–22] While the impact of complications on prognosis has been examined among patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma, the effect on EHBM has not been studied. [14, 17] In addition, many previous studies have only considered complications as an aggregate variable, failing to examine the effect of specific complications on prognosis. Given that surgical site infections (SSI) are one of the most common complications, we sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of EHBM using a large, multi-center, national cohort dataset.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Buettner

Ethun

Poultsides

et al. 2017

Journal of Gastrointestinal Surgery

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Background Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Complications may lead to an associated immune-modulatory effect that inhibits the body’s response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extra-hepatic bilary malignancies (EHBM). Methods Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. Results 728 patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection liver resection was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n=70, 9.6%) or formation of an abscess in the operative bed (n=91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08–1.80; p=0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03–3.29; p=0.038), as well as overall survival (HR 1.87, 95% CI 1.18–2.97; p=0.008). Conclusion SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of post-operative SSI was adversely associated with long-term survival.

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Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

et al. 2021

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IMPORTANCE Textbook outcome (TO) is a composite measure that captures the most desirable surgical outcomes as a single indicator, yet to date TO has not been defined and assessed in the field of laparoscopic liver resection (LLR) and open liver resection (OLR).OBJECTIVE To obtain international agreement on the definition of TO in liver surgery (TOLS) and to assess the incidence of TO in LLR and OLR in a large international multicenter database using a propensity-score matched analysis.DESIGN, SETTING, AND PARTICIPANTS Patients undergoing LLR or OLR for all liver diseases between January 2011 and October 2019 were analyzed using a large international multicenter liver surgical database. An international survey was conducted among all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) and International Hepato-Pancreato-Biliary Association (IHPBA) to reach agreement on the definition of TOLS. The rate of TOLS was assessed for LLR and OLR before and after propensity-score matching. Factors associated with achieving TOLS were investigated.MAIN OUTCOMES AND MEASURES Textbook outcome, with TOLS defined as the absence of intraoperative incidents of grade 2 or higher, postoperative bile leak grade B or C, severe postoperative complications, readmission within 30 days after discharge, in-hospital mortality, and the presence of R0 resection margin.RESULTS A total of 8188 patients (4559 LLR; median age, 65 years [interquartile range, 55-73 years]; 2529 were male [55.8%] and 3629 OLR; median age, 64 years [interquartile range, 56-71 years]; 2204 were male [60.7%]) were included in the analysis of whom 69.1% achieved TOLS; 74.8% for LLR and 61.9% for OLR (P < .001). On multivariable analysis, American Society of Anesthesiologists grade III, previous abdominal surgery, histological diagnosis of colorectal liver metastases (odds ratio [OR], 0.656 [95% CI, 0.457-0.940]; P = .02), cholangiocarcinoma, non-CRLM, a tumor size of 30 mm or more, minor resection of posterior/superior segments (OR, 0.716 [95% CI, 0.577-0.887]; P = .002), anatomically major resection (OR, 0.579 [95% CI, 0.418-0.803]; P = .001), and nonanatomical resection (OR, 0.612 [95% CI, 0.476-0.788]; P < .001) were associated with a worse TOLS rate after LLR. For OLR, only histological diagnosis of cholangiocarcinoma (OR, 0.360 [95% CI, 0.214-0.607]; P < .001) and a tumor size of 30 mm or more (30-50 mm = OR, 0.718 [95% CI, 0.565-0.911]; P = .01; 50.1-100 mm = OR, 0.729 [95% CI, 0.554-0.960]; P = .02; >10 cm = OR, 0.550 [95% CI, 0.366-0.826]; P = .004) were associated with a worse TOLS rate. CONCLUSIONS AND RELEVANCEIn this multicenter study, TOLS was found to be a useful tool for assessing patient-level hospital performance and may have utility in optimizing patient outcomes after LLR and OLR.

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Prognostic impact of complications after resection of early stage hepatocellular carcinoma

Cited by 61 publications

References 45 publications

Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Impact of postoperative infective complications on long-term survival after liver resection for hepatocellular carcinoma

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

Assessment of Textbook Outcome in Laparoscopic and Open Liver Surgery

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