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Journal of Hepato-Biliary-Pancreatic Sciences

Published in:

01-02-2013 | Original Article

Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases

Authors: Hiroshi Sadamori, Takahito Yagi, Susumu Shinoura, Yuzo Umeda, Ryuichi Yoshida, Daisuke Satoh, Daisuke Nobuoka, Masashi Utsumi, Kazuhiro Yoshida, Toshiyoshi Fujiwara

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 2/2013

Abstract

Background

Surgical site infections (SSIs), particularly organ/space SSIs, remain a common cause of major morbidity after hepatectomy for hepatocellular carcinoma (HCC).

Methods

Risk factors for SSIs were analyzed in 359 patients who underwent hepatectomy for HCC between 2001 and 2010. The causative bacteria, management, outcome, and characteristics of organ/space SSIs were investigated.

Results

Anatomic hepatectomy was performed for 296 patients (82.5%), and repeat hepatectomy was carried out for 59 patients (16.4%). SSIs developed in 52 patients (14.5%; incisional, 24 cases; organ/space, 31 cases [3 patients showed both incisional and organ/space SSIs]). No in-hospital mortality related to incisional or organ/space SSIs was encountered. Independent risk factors for SSIs were repeat hepatectomy and operative time ≥280 min. Independent risk factors for organ/space SSIs were repeat hepatectomy and bile leakage. Methicillin-resistant Staphylococcus aureus was detected more frequently in organ/space SSIs after repeat hepatectomy than after initial hepatectomy.

Conclusions

Repeat hepatectomy and bile leakage represent independent risk factors for organ/space SSIs after hepatectomy for HCC. Establishing treatment strategies is important for preventing postoperative bile leakage and reducing the high rate of organ/space SSIs after repeat hepatectomy.

Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg. 1999;229:323–30.CrossRef

Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg. 1999;229:790–800.PubMedCrossRef

Torzilli G, Makuuchi M, Inoue K, Takayama T, Sakamoto Y, Sugawara Y, et al. No mortality liver resection for hepatocellular carcinoma in cirrhotic and noncirrhotic patients. Arch Surg. 2007;134:984–92.CrossRef

Shimada M, Takenaka K, Fujiwara Y, Gion T, Shirabe K, Yanaga K, et al. Risk factors linked to postoperative morbidity in patients with hepatocellular carcinoma. Br J Surg. 1998;85:195–8.PubMedCrossRef

Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191:38–46.PubMedCrossRef

Capussotti L, Muratore A, Amisano M, Polastri R, Bouzari H, Massucco P. Liver resection for hepatocellular carcinoma on cirrhosis: analysis of mortality, morbidity and survival—a European single center experience. Eur J Surg Oncol. 2005;31:986–93.PubMedCrossRef

Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg. 2007;204:580–7.PubMedCrossRef

Virani S, Michaelson J, Hutter M, Lancaster RT, Warshaw AL, Henderson WG, et al. Morbidity and mortality after liver resection: results of the Patient Safety in Surgery study. J Am Coll Surg. 2007;204:1284–92.PubMedCrossRef

Sadamori H, Yagi T, Matsuda H, Shinoura S, Umeda Y, Yoshida R, et al. Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases. J Hepatobiliary Pancreat Sci. 2010;17:709–18.PubMedCrossRef

10.

CDC NNIS System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 to June 2004, issued October 2004. Am J Infect Control. 2004;32:470–85.

11.

Hasegawa K, Kokudo N, Imamura H, Matsuyama Y, Aoki T, Minagawa M, et al. Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg. 2005;242:252–9.PubMedCrossRef

12.

Eguchi S, Kanematsu T, Arii S, Okazaki M, Okita K, Omata M, Liver Cancer Study Group of Japan, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey. Surgery. 2008;143:469–75.PubMedCrossRef

13.

Sadamori H, Matsuda H, Shinoura S, Umeda Y, Yoshida R, Satoh D, et al. Anatomical subsegmentectomy in the lateral segment for hepatocellular carcinoma. Hepatogastroenterology. 2009;56:971–7.PubMed

14.

Farges O, Regimbeau JM, Belghiti J. Aggressive management of recurrence following surgical resection of hepatocellular carcinoma. Hepatogastroenterology. 1998;45:1275–80.PubMed

15.

Shimada M, Takenaka K, Taguchi K, Fujiwara Y, Gion T, Kajiyama K, et al. Prognostic factors after repeat hepatectomy for recurrent hepatocellular carcinoma. Ann Surg. 1998;227:80–5.PubMedCrossRef

16.

Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg. 1999;229:216–22.PubMedCrossRef

17.

Minagawa M, Makuuchi M, Takayama T, Kokudo N. Selection criteria for repeat hepatectomy in patients with recurrence hepatocellular carcinoma. Ann Surg. 2003;238:703–10.PubMedCrossRef

18.

Itamoto T, Nakahara H, Amano H, Kohashi T, Ohdan H, Tashiro H, et al. Repeat hepatectomy for recurrent hepatocellular carcinoma. Surgery. 2007;141:589–97.PubMedCrossRef

19.

Umeda Y, Matsuda H, Sadamori H, Matsukawa H, Yagi T, Fujiwara T. A prognostic model and treatment strategy for intrahepatic recurrence of hepatocellular carcinoma after curative resection. World J Surg. 2011;35:170–7.PubMedCrossRef

20.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef

21.

Wu CC, Yeh DC, Lin MC, Liu TJ, P’eng FK. Prospective randomized trial of systemic antibiotics in patients undergoing liver resection. Br J Surg. 1998;85:489–93.PubMedCrossRef

22.

Togo S, Matsuo K, Tanaka K, Matsumoto C, Shimizu T, Ueda M, et al. Perioperative infection control and its effectiveness in hepatectomy. J Gastroenterol Hepatol. 2007;22:1942–8.PubMedCrossRef

23.

Shiba H, Ishii Y, Ishida Y, Wakiyama S, Sakamoto T, Ito R, et al. Assessment of blood-products use as predictor of pulmonary complications and surgical infection after hepatectomy for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2009;16:69–74.PubMedCrossRef

24.

Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Yatabe T, Maeda H, et al. Risk factors and predictors for surgical site infection after hepatic resection. J Hosp Infect. 2009;73:47–53.PubMedCrossRef

25.

Kobayashi S, Gotohda N, Nakagohri T, Takahashi S, Konishi M, Kinoshita T. Risk factors of surgical site infection after hepatectomy for liver cancers. World J Surg. 2009;33:312–7.PubMedCrossRef

26.

Uchiyama K, Ueno M, Ozawa S, Kiriyama S, Kawai M, Hirono S, et al. Risk factors for postoperative infectious complications after hepatectomy. J Hepatobiliary Pancreat Sci. 2011;18:67–73.PubMedCrossRef

27.

Togo S, Kubota T, Takahashi T, Yoshida K, Matsuo K, Morioka D, et al. Usefulness of absorbable sutures in preventing surgical site infection in hepatectomy. J Gastrointest Surg. 2008;12:1041–6.PubMedCrossRef

28.

Arikawa T, Kurokawa T, Ohwa Y, Ito N, Kotake K, Nagata H, et al. Risk factors for surgical site infection after hepatectomy for hepatocellular carcinoma. Hepatogastroenterology. 2011;58:143–6.PubMed

29.

Wong R, Rappaport W, Witte C, Hunter G, Jaffe P, Hall K, et al. Risk of nonshunt abdominal operation in the patient with cirrhosis. J Am Coll Surg. 1994;179:412–6.PubMed

30.

Mansour A, Watson W, Shayani V, Pickleman J. Abdominal operations in patients with cirrhosis: still a major surgical challenge. Surgery. 1997;122:730–5.PubMedCrossRef

31.

Pessaux P, Msika S, Atalla D, Hay JM, Flamant Y, French Association for Surgical Research. Risk factors for postoperative infectious complications in noncolorectal abdominal surgery: a multivariate analysis based on a prospective multicenter study of 4718 patients. Arch Surg. 2003;138:314–24.PubMedCrossRef

32.

Schindl MJ, Millar AM, Redhead DN, Fearon KC, Ross JA, Dejong CH, et al. The adaptive response of the reticuloendothelial system to major liver resection in humans. Ann Surg. 2006;243:507–14.PubMedCrossRef

33.

Schindl MJ, Redhead DN, Fearon KC, Garden OJ, Wigmore SJ, Edinburgh Liver Surgery and Transplantation Experimental Research Group (eLISTER). The value of residual liver volume as a predictor of hepatic dysfunction and infection after major liver resection. Gut. 2005;54:289–96.PubMedCrossRef

34.

Yanaga K, Kanematsu T, Takenaka K, Sugimachi K. Intraperitoneal septic complications after hepatectomy. Ann Surg. 1986;203:148–52.PubMedCrossRef

35.

Anderson R, Saarela A, Tranberg KG, Bengmark S. Intraabdominal abscess formation after major liver resection. Acta Chir Scand. 1990;156:707–10.

36.

Nagasue N, Kohno H, Tachibana M, Yamanoi A, Ohmori H, EI-Assai O. Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte class B and C cirrhosis. Ann Surg. 1999;229:84–90.PubMedCrossRef

37.

Walsh EE, Greene L, Kirshner R. Sustained reduction in methicillin-resistant Staphylococcus aureus wound infections after cardiothoracic surgery. Arch Intern Med. 2011;171:68–73.PubMedCrossRef

38.

Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg. 2009;249:20–5.PubMedCrossRef

39.

Choi D, Lim HK, Rhim H, Kim YS, Yoo BC, Paik SW, et al. Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy: long-term results and prognostic factors. Ann Surg Oncol. 2007;14:2319–29.PubMedCrossRef

40.

Taura K, Ikai I, Hatano E, Fujii H, Uyama N, Shimahara Y. Implication of frequent local ablation therapy for intrahepatic recurrence in prolonged survival of patients with hepatocellular carcinoma undergoing hepatic resection: an analysis of 610 patients over 16 years old. Ann Surg. 2006;244:265–73.PubMedCrossRef

Title: Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases
Authors: Hiroshi Sadamori
Takahito Yagi
Susumu Shinoura
Yuzo Umeda
Ryuichi Yoshida
Daisuke Satoh
Daisuke Nobuoka
Masashi Utsumi
Kazuhiro Yoshida
Toshiyoshi Fujiwara
Publication date: 01-02-2013
Publisher: Springer Japan
Published in: Journal of Hepato-Biliary-Pancreatic Sciences / Issue 2/2013
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI: https://doi.org/10.1007/s00534-011-0503-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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