Abstract
Introduction
Postoperative infectious complications (PIC) remain one of the most common complications
after surgery. The influence of PIC on long-term survival for patients after liver
surgery for colorectal liver metastases (CRLM) needs further investigation.
Methods
Data of patients who underwent liver resection for CRLM between 2012 and 2017 at the
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité –
Universitätsmedizin Berlin were evaluated. Overall survival (OS) was stratified according
to the development of PIC. Independent predictors of PIC and diminished survival were
identified using regression models.
Results
Of 270 patients, eighty-four (31%) patients developed PIC including intraabdominal
infections (n = 51, 61%), cholangitis (n = 5, 6%), pneumonia (n = 12, 14%), wound
infections (n = 28, 33%), urinary tract infections (n = 5, 6%), or central line-associated
bloodstream infections (n = 4, 5%). PIC were associated with a significantly diminished
five-year OS (30% vs. 43%, p = 0.008). Age >65 years (p = 0.016, hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.2–4.0), comorbidity
(p = 0.019, HR [95% CI] = 2.4 [1.2–4.9]), simultaneous resection of primary tumor (p = 0.005, HR [95% CI] = 4.3 [1.6–11.9]), biliary drainage (p < 0.001, HR [95% CI] = 4.1 [2.0–8.5]), and length of procedure ≥272 min (p = 0.012, HR [95% CI] = 2.2 [1.2–4.1]) were independent predictors for the development
of PIC. Body-mass index (BMI) > 30 kg/m2 (p = 0.002, HR [95% CI] = 2.4 [1.4–4.0]), postoperative major complications (p = 0.003, HR [95% CI] = 2.2 [1.3–3.8]), and 3- or 4-MRGN bacteria (p = 0.001, HR [95% CI] = 7.7 [2.2–27.3]) were independently associated with diminished
OS.
Conclusions
PIC are associated with diminished OS after resection for CRLM. Age >65 years, comorbidities,
simultaneous resection of the primary tumor, and biliary drainages were identified
as independent risk factors for the development of PIC. High BMI, postoperative major
morbidity and 3-/4-MRGN bacteria were independently predictive of worse OS. These
factors need to be considered in perioperative management for patients with CRLM.
Keywords
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Article info
Publication history
Published online: April 26, 2023
Accepted:
April 25,
2023
Received in revised form:
March 20,
2023
Received:
May 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
