Postoperative infectious complications after liver resection

Laparoscopic in comparison to open surgery reduces surgical trauma, the inflammatory response and infectious complications and minimizes immunosuppression. Large sizes of tumors, biliary or vascular reconstruction are the only obstacles to the widespread use of laparoscopic liver resections. Numerous clinical studies have demonstrated a significant reduction in postoperative pain, hospital length of stay, postoperative morbidity and recovery times.

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A Randomized Clinical Trial of Early Enteral Nutrition to Prevent Infectious Complications in Patients With Extensive Liver Resection

International Surgery ◽

10.9738/intsurg-d-15-00060.1 ◽

2015 ◽

Vol 100 (11-12) ◽

pp. 1414-1423

Author(s):

Daisuke Kawaguchi ◽

Yukihiko Hiroshima ◽

Kenichi Matsuo ◽

Keiji Koda ◽

Itaru Endo ◽

...

Keyword(s):

Clinical Trial ◽

Liver Resection ◽

Enteral Nutrition ◽

Randomized Clinical Trial ◽

Infectious Complications ◽

Study Endpoint ◽

Primary Study ◽

Early Enteral Nutrition ◽

Significant Difference ◽

Postoperative Serum

After major liver resections, infections and liver insufficiency are the most common complications; these may coincide. We performed a randomized clinical trial to clarify ability of early enteral nutrition to prevent infectious complications and liver failure following major hepatectomy. We prospectively allocated consecutive patients who underwent major liver resection into either an early enteral nutrition group in which such nutrition was initiated on the first postoperative day or a nonenteral nutrition group. The primary study endpoint was rate of infectious complications. Thirty-two patients were randomly allocated to the enteral nutrition group, while 31 were assigned to the nonenteral nutrition group. No significant difference in rate of infection complications was evident between enteral (9.4%) and nonenteral group (22.6%, P = 0.184). However, complications of grade III severity or worse were significantly less frequent in the enteral (9.4%) than in the nonenteral group (32.3%, P = 0.031). Further, postoperative serum concentrations of pre-albumin and reduced-state albumin were greater in the enteral than in the nonenteral group. Early enteral nutrition did not significantly improve prevention of infectious complications, but some effectiveness in preventing severe complications and improving nutritional status was demonstrated.

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P103 POSTOPERATIVE EARLY HYPERGLYCEMIA PREDICTS INFECTIOUS COMPLICATIONS AFTER LIVER RESECTION

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(08)70165-0 ◽

2008 ◽

Vol 3 ◽

pp. 72-73

Author(s):

S. Haji ◽

S. Satoi ◽

W. Shinzaki ◽

H. Ohyanagi

Keyword(s):

Liver Resection ◽

Infectious Complications

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Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

PLoS ONE ◽

10.1371/journal.pone.0262113 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262113

Author(s):

Hon-Fan Lai ◽

Ivy Yenwen Chau ◽

Hao-Jan Lei ◽

Shu-Cheng Chou ◽

Cheng-Yuan Hsia ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Liver Resection ◽

Serum Albumin ◽

Predictive Value ◽

Infectious Complication ◽

Infectious Complications ◽

Low Grade ◽

Postoperative Fever ◽

Grade Iii

Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.

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Postoperative infectious complications after liver resection for hepatocellular carcinoma

Journal of Cancer Research and Therapeutics ◽

10.4103/0973-1482.200754 ◽

2016 ◽

Vol 12 (8) ◽

pp. 268 ◽

Cited By ~ 2

Author(s):

Yi Jin ◽

Yuan Zhao ◽

Yueming Wu

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Infectious Complications

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Perioperative outcomes following composite resections for colorectal cancer with liver metastases: Can we do better?

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.412 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 412-412

Author(s):

Jane Yuet Ching Hui ◽

Tianyu Li ◽

Eric A. Ross ◽

Nestor F. Esnaola

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Liver Resection ◽

Liver Metastases ◽

Cost Effective ◽

Infectious Complications ◽

Adverse Outcomes ◽

Independent Effect ◽

Perioperative Outcomes ◽

Improvement Program

412 Background: Curative resection for synchronous colorectal cancer and liver metastases (CRC/LM) can be performed simultaneously as composite resections or in isolation as staged resections. Composite resections expedite care and may be more cost-effective, but there is persistent controversy regarding their safety. This study aimed to identify potentially modifiable differences in adverse perioperative outcomes after composite versus (vs) isolated resection for CRC/LM. Methods: All patients (pts) with CRC/LM in the American College of Surgeons-National Surgical Quality Improvement Program Participant Use File who underwent elective colon, rectal, and/or liver resections from 2005 to 2013 were identified. Patient/procedure characteristics and perioperative outcomes were compared in pts who had isolated colon or rectal resection (CR or RR), isolated liver resection (LR), or composite colon/liver or rectal/liver resection (CLR or RLR) using chi square or Wilcoxon tests. Multiple logistic regression models were used to determine the independent effect of resection type on outcomes. Results: 13,523 pts underwent CR (3,601; 26.6%), RR (2,018; 14.9%), LR (7,002; 51.8%), CLR (513; 3.8%), or RLR (389; 2.9%). In colon cancer pts, the 30-day (30-d) rate of death/serious complication (DSC) was significantly higher after CLR (33.7%) than after CR (22.0%; adjusted odds ratio [aOR] 0.41, 95% confidence interval [95% CI], 0.33 to 0.52) or LR (13.9%; aOR 0.33; 95% CI, 0.27 to 0.41). Similarly, in rectal cancer pts, the 30-d rate of DSC was significantly higher after RLR (24.7%) than after RR (21.5%; aOR 0.66; 95% CI, 0.50 to 0.88) or LR (13.9%; aOR 0.47; 95% CI, 0.36 to 0.62). Differences in adverse outcomes following composite resections were not due to mortality, but to higher rates of pulmonary/infectious complications and returns to the operating room. Conclusions: Composite resections for CRC/LM are associated with higher rates of DSC, particularly in colon cancer pts. Aggressive targeted strategies to prevent pulmonary and infectious complications could significantly improve outcomes in pts undergoing composite resections for synchronous CRC/LM.

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