Journal of Cancer Research and Therapeutics

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 12  |  Issue : 8  |  Page : 268--270

Postoperative infectious complications after liver resection for hepatocellular carcinoma


Yuan Zhao1, Yi Jin2, Yueming Wu2,  
1 Department of Liver Diseases, Lishui People's Hospital (The 6th Affiliated Hospital of Wenzhou Medical University), Zhejiang, Lishui 323000, PR China
2 Department of EICU, Lishui People's Hospital (The 6th Affiliated Hospital of Wenzhou Medical University), Zhejiang, Lishui 323000, PR China

Correspondence Address:
Yi Jin
Department of EICU, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000
PR China

Abstract

Objective: The purpose of this study was to evaluate the postoperative infectious complications after liver resection for hepatocellular carcinoma by logistic regression analysis. Materials and Methods: One hundred and sixty-six hepatocellular carcinoma patients who received surgery were retrospectively reviewed and included in this study. Of the included 166 patients, 42 patients had the postoperative infectious complications (case group) and other 124 patients did not develop postoperative infection (control group). The clinical characteristics (gender, chronic disease history) and operation-related factors were compared between the two groups. Moreover, independent risk factors for postoperative infectious complications were assessed by logistic regression analysis. Results: Statistical difference was found in the aspects of diabetes (P < 0.05), plasma albumin (P < 0.05), operation time (P < 0.05), blood loss (P < 0.05), biliary fistula (P < 0.05), and drainage time (P < 0.05). Logistic regression analysis indicated that plasma albumin <35 g/L (odds ratio [OR] =2.21, P < 0.05), blood loss >500 ml (OR = 2.65, P < 0.05), and biliary fistula (OR = 2.77, P < 0.05) were the independent risk factors for postoperative infectious complications. Conclusion: Patients with plasma albumin <35 g/L, intraoperative blood loss > 500 ml, and postoperative drainage time >72 h are more likely to develop positive infectious complications.



How to cite this article:
Zhao Y, Jin Y, Wu Y. Postoperative infectious complications after liver resection for hepatocellular carcinoma.J Can Res Ther 2016;12:268-270


How to cite this URL:
Zhao Y, Jin Y, Wu Y. Postoperative infectious complications after liver resection for hepatocellular carcinoma. J Can Res Ther [serial online] 2016 [cited 2022 Aug 10 ];12:268-270
Available from: https://www.cancerjournal.net/text.asp?2016/12/8/268/200754


Full Text

 Introduction



Hepatocellular carcinoma is one of the most diagnosed malignant tumors clinically.[1] The most used treatment process is hepatectomy for nonmetastasis stage disease.[2] Because of decreased liver function [3] and immune ability, the postoperative infection rate was relatively high such as incision infection, abdominal abscess infection, pulmonary infection, and urinary tract infection.[4] It was reported that the positive infection rate for hepatectomy in patients of hepatocellular carcinoma ranges from 10% to 25%.[5] The postoperative infection complication prolonged the hospitalization, increased the suffering of patients, and even affected the prognosis. Therefore, it is important to evaluate the independent risk factors for postoperative infection complication. In this retrospective study, we included 166 hepatocellular carcinoma patients who received surgical treatment and further analyzed the independent risk factors for positive operative infection complications by logistic regression analysis.

 Materials and Methods



Patients inclusion

One hundred and sixty-six hepatocellular carcinoma patients who received surgery were retrospectively reviewed and included in this study from January 2011 to June 2016 in Lishui People's Hospital. The inclusion criteria were (1) the patients were pathology confirmed hepatocellular carcinoma; (2) the age between 18 and 70 years old; (3) the liver function were restriction to A and B according to Child-Pugh classification system; (4) no remote metastasis lesions were found; (5) relative completely clinical and follow-up information. The exclusion criteria were (1) not enough clinical and follow-up information; (2) not hepatocellular carcinoma patients; (3) HIV-positive patients. According to the inclusion and exclusion criteria, 166 patients were included in this study. Of the included 166 patients, 42 patients had the postoperative infectious complications (case group) and other 124 patients did not develop postoperative infection (control group). The general information of the included 166 patients is shown in [Table 1].{Table 1}

General information and intraoperative information extraction

An information questionnaire was made to investigate the general and operation-related factors. The general information included gender, age, and chronic disease histories such as hypertension, coronary disease, and diabetes. The intraoperative information included operation time, blood loss, and operation method.

Postoperative infectious complications definition

Surgical site infection includes surgical incision infection and abdominal abscess. Incision infection was confirmed by the clinical symptom of swelling, local skin temperature rise, and positive bacterial culture. Abdominal infection was confirmed by purulent secretion and bacterial culture in the abdominal cavity.

Statistical analysis

Statistical Package for Social Sciences 17.0 (http://www-01.ibm.com) statistical software for Windows 17.0 was used for the statistical analysis of the data. Demographics of the patients were given as number, percentage, and mean value. Chi-square test was used to determine the difference between case and control groups, and two-tailed P < 0.05 was deemed as statistical difference.

 Results



General baseline of the two groups

Statistical difference was found in the aspects of diabetes (P < 0.05) and plasma albumin (P < 0.05) between the two groups. However, for gender (P > 0.05), age (P > 0.05), hypertension (P > 0.05), and coronary disease (P > 0.05), there was no statistical difference [Table 1].

Intraoperative comparison

The operation time (P < 0.05), blood loss (P < 0.05), biliary fistula (P < 0.05), and drainage time (P < 0.05) were statistically different between the two groups [Table 2].{Table 2}

Logistic regression analysis

Logistic regression analysis indicated that plasma albumin <35 g/L (odds ratio [OR] =2.21, P < 0.05), blood loss >500 ml (OR = 2.65, P < 0.05), and biliary fistula (OR = 2.77, P < 0.05) were the independent risk factors for postoperative infectious complications [Figure 1].{Figure 1}

 Discussion



Primary hepatocellular carcinoma is most diagnosed malignant carcinoma clinically.[6] The epidemiology study showed about 300,000 patients died of hepatocellular carcinoma each year in China.[7] With the development of cancer treatment methods, more and more process of hepatocellular carcinoma treatment has been developed such as interventional therapy, radiofrequency ablation therapy, and microwave ablation therapy.[8],[9] However, for early-stage primary hepatocellular carcinoma, the most useful treatment is still hepatolobectomy, which can provide relatively well prognosis and 5-year survival rate.[10],[11] However, for decreased liver function and immune ability, the postoperative infection rates such as incision infection, abdominal abscess infection, pulmonary infection, and urinary tract infection were relatively high in patients who received operation. Lu et al.[12] have analyzed the postoperative complications for 2837 hepatocellular carcinoma patients treated with surgery. They found that the general postoperative complication was 40%, with infection of 25%. Thus, the positive operative infection was one of the most happened complications. In our present study, we retrospectively analyzed 166 hepatocellular carcinoma patients who received the operation and we found that 42 patients had developed the postoperative infection complication with the incidence rate of 25.3%, which was in accordance with Jin's study.[12] Moreover, we further found that the aspects of diabetes (P < 0.05), plasma albumin (P < 0.05), operation time (P < 0.05), blood loss (P < 0.05), biliary fistula (P < 0.05), and drainage time (P < 0.05) were statistically different between the two groups. Logistic regression analysis indicated that plasma albumin<35 g/L (OR = 2.21, P < 0.05), blood loss >500 ml (OR = 2.65, P < 0.05), and biliary fistula (OR = 2.77, P < 0.05) were the independent risk factors for postoperative infectious complications.

 Conclusion



Patients with plasma albumin <35 g/L, intraoperative blood loss >500 ml, and postoperative drainage time >72 h are more likely to develop positive infectious complications. The doctors must pay more attention to these patients to decrease the positive operative infection complication rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.
2Chan SL, Chong CC, Chan AW, Poon DM, Chok KS. Management of hepatocellular carcinoma with portal vein tumor thrombosis: Review and update at 2016. World J Gastroenterol 2016;22:7289-300.
3Kokudo T, Hasegawa K, Amikura K, Uldry E, Shirata C, Yamaguchi T, et al. Assessment of preoperative liver function in patients with hepatocellular carcinoma – The Albumin-Indocyanine Green Evaluation (ALICE) Grade. PLoS One 2016;11:e0159530.
4Naito S, Imamura H, Tukada A, Matsuyama Y, Yoshimoto J, Sugo H, et al. Postoperative recurrence pattern and prognosis of patients with hepatocellular carcinoma, with particular reference to the hepatitis viral infection status. Liver Int 2014;34:802-13.
5Omichi K, Shindoh J, Yamamoto S, Matsuyama Y, Akamatsu N, Arita J, et al. Postoperative outcomes for patients with non-B non-C hepatocellular carcinoma: A subgroup analysis of patients with a history of hepatitis B infection. Ann Surg Oncol 2015;22 Suppl 3:S1034-40.
6Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90.
7Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. CA Cancer J Clin 2016;66:115-32.
8Zhang S, Yue M, Shu R, Cheng H, Hu P. Recent advances in the management of hepatocellular carcinoma. J BUON 2016;21:307-11.
9Nakayama H, Takayama T. Management before hepatectomy for hepatocellular carcinoma with cirrhosis. World J Hepatol 2015;7:2292-302.
10Bellissimo F, Pinzone MR, Cacopardo B, Nunnari G. Diagnostic and therapeutic management of hepatocellular carcinoma. World J Gastroenterol 2015;21:12003-21.
11Ruiz I, Feray C. Current management of hepatocellular carcinoma. Cancer Radiother 2015;19:410-5.
12Lu J. Risk factors of postoperative pulmonary infection in patients with hepatocellular carcinoma. Chin J Nosocomiology 2013;23:2348-50.