Association Between Postoperative Infectious Complications and Long-term Prognosis After Hepatic Resection for Hepatocellular Carcinoma A Multicenter Study of 2,442 patients

Introduction: Postoperative complications greatly impact postoperative course and long-term prognosis following major cancer surgery. Among them, infectious complications play a relevant role. While, the effect of postoperative infectious complications on the long-term prognosis following hepatic resection for hepatocellular carcinoma (HCC) has not been well-defined. The objective of the present study was to evaluate whether postoperative infectious complications impact long-term prognosis among patients with HCC undergoing hepatic resection. Method: From a multi-institutional database, patients who underwent curative resections for HCC were retrospectively analyzed. Independent risk factors of postoperative infectious complications were identified. Postoperative early deaths (≤ 90 days) were highly associated with postoperative complications. In order to eliminate confounding effect, patients with postoperative early deaths were excluded. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients with and without postoperative 30-day infectious complications. Result: Among 2,442 patients identified, 332 (13.6%) had postoperative 30-day infectious complications. Age > 60 years, diabetes mellitus, obesity, cirrhosis, intraoperative blood transfusion, operative time > 180 min and major hepatectomy were identified as independent risk factors of postoperative infectious complications. The 1-, 3- and 5-year OS rates among patients with and without postoperative infectious complications were 83.8, 61.4 and 46.5%, and 87.1, 69.2 and 58.2%, respectively. The 1-, 3- and 5-year RFS rates among patients with and without postoperative infectious complications were 61.8, 40.6, and 32.0%, and 70.4, 52.8, and 42.5%, respectively. After adjustment for other prognostic factors, multivariable Cox-regression analyses identified postoperative infectious complications were independently associated with decreased OS (HR1.199, 95%CI:1.021-1.660, P=0.027) and RFS (HR1.187, 95%CI:1.027-1.372, P=0.021). Conclusion: Postoperative infectious complications decrease long-term OS and RFS in patients treated with hepatic resection for HCC. To reduce the incidence of postoperative infectious complications and improve long-term oncologic prognosis after HCC resection, preoperative optimization, surgical procedure and postoperative care should be carefully planned.