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Postoperative Infectious Complications Impact Long-Term Survival in Patients Who Underwent Hepatectomies for Colorectal Liver Metastases: a Propensity Score Matching Analysis

  • Riccardo Memeo
  • Vito de Blasi
  • Rene Adam
  • Diane Goéré
  • Alexis Laurent
  • Nicola de’Angelis
  • Tullio Piardi
  • Emilie Lermite
  • Astrid Herrero
  • Francis Navarro
  • Antonio Sa Cunha
  • Patrick Pessaux
  • on behalf of the French colorectal liver metastases working group - Association Française de Chirurgie (AFC)
Original Article

Abstract

Objective

Postoperative complications strongly impact the postoperative course and long-term outcome of patients who underwent liver resection for colorectal liver metastases (CRLM). Among them, infectious complications play a relevant role. The aim of this study was to evaluate if infectious complications still impact overall and disease-free survival after liver resection for CRLM once patients were matched with a propensity score matching analysis based on Fong’s criteria.

Methods

A total of 2281 hepatectomies were analyzed from a multicentric retrospective cohort of hepatectomies. Patients were matched with a 1:3 propensity score analysis in order to compare patients with (INF+) and without (INF−) postoperative infectious complications.

Results

Major resection (OR = 1.69 (1.01–2.89), p = 0.05) and operative time (OR = 1.1 (1.1–1.3), p = 0.05) were identified as risk factors of infectious complications. After propensity score matching, infectious complications are associated with overall survival (OS), with 1-, 3-, 5-year OS at 94, 81, and 66% in INF− and 92, 66, and 57% in INF+ respectively (p = 0.01). Disease-free survival (DFS) was also different with regard to 1-, 3-, 5-year survival at 65, 41, and 22% in R0 vs. 50, 28, and 17% in INF+ (p = 0.007).

Conclusion

Infectious complications are associated with decreased overall and disease-free survival rates.

Keywords

Hepatectomy Morbidity Infectious Metastases Survival Propensity score 

Notes

Acknowledgments

The authors would like to thank all participating centers for their contribution to this study. Authors would also like to thank Christopher Burel, Iana Shutrova, and Guy Temporal, professional medical proofreaders, for their assistance in revising the manuscript. Contributors: Amiens, CHU Amiens Picardie: Cyril Cosse, Delphine Lignier, Jean Marc Regimbeau; Angers, CHU Angers: Julien Barbieux, Emilie Lermite, Antoine Hamy; Beauvais, CH Beauvais: François Mauvais; Bordeaux, Groupe Hospitalier Saint André: Christophe Laurent; Chambéry, CH Chambéry: Irchid Al Naasan; Créteil, CHU Henri Mondor: Alexis Laurent, Philippe Compagnon; Eaubonne, Hôpital Simone Veil: Mohammed Sbai Idrissi; Epinal, Polyclinique de la Ligne Bleue: Frédéric Martin; Gap, CH des Alpes du Sud: Jérôme Atger; Lyon, Hôpital de la Croix Rousse: Jacques Baulieux, Benjamin Darnis, Jean Yves Mabrut; Lyon, Hôpital Edouard Herriot: Vahan Kepenekian, Julie Perinel, Mustapha Adham; Lyon, CH Lyon Sud: Olivier Glehen; Lyon, Centre Léon Bérard: Michel Rivoire; Marseille, Hôpital de la Conception: Jean Hardwigsen, Anaïs Palen, Yves Patrice Le Treut; Marseille, Institut Paoli-Calmettes: Jean Robert Delpero, Olivier Turrini; Montpellier, Hôpital Saint Eloi: Astrid Herrero, Fabrizio Panaro; Nancy, CHU Brabois: Laurent Bresler; Nancy, Institut de Cancérologie de Lorraine Alexis-Vautrin: Philippe Rauch, François Guillemin, Frédéric Marchal; Nice, Hôpital de l’Archet: Jean Gugenheim, Antonio Iannelli; Kremlin-Bicêtre, CHU Kremlin-Bicêtre: Stéphane Benoist, Antoine Brouquet; Paris, Hôpital Lariboisière: Marc Pocard, Rea Lo Dico; Paris, Institut Mutualiste Montsouris: David Fuks; Paris, Hôpital Saint Antoine: Olivier Scatton, Olivier Soubrane; Paris, Hôpital de la Pitié Salpétrière: Jean-Christophe Vaillant; Reims, Hôpital Robert Debré: Tullio Piardi, Daniel Sommacale, Reza Kianmanesh; La Roche-sur-Yon, Centre Départemental de Vendée: Michel Comy; Strasbourg, Hôpital de Hautepierre: Philippe Bachelier, Elie Oussoultzoglou, Pietro Addeo; Strasbourg, Nouvel Hôpital Civil: Dimitrios Ntourakis, Didier Mutter, Jacques Marescaux; Toulouse, Hôpital Rangueil: Loïc Raoux, Bertrand Suc, Fabrice Muscari; Troyes, Hôpital des Hauts-Clos: Georges ELHOMSY; Villejuif, Hôpital Paul Brousse: Maximiliano Gelli, Denis Castaing, Daniel Cherqui; Gabriella PIttau, Oriana Ciacio, Eric Vibert; Villejuif, Gustave Roussy: Dominique Elias, Fabrizio Vittadello.

Authors’ Contribution

RM, VDB, RA, DG, AL, NDA, TP, EL, AH, FN, AS, PP contributed to the conception or design of the work;

RM, VDB, RA, DG contributed to the acquisition, analysis, or interpretation of data for the work;

RM, VDB, RA, DG, AL, NDA, TP, EL, AH, FN, AS, PP contributed to the drafting of the work and revising it critically for important intellectual content;

EL, AH, FN, AS, PP finally approved the version to be published;

Compliance with Ethical Standards

Disclosures

The authors have nothing to disclose.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Riccardo Memeo
    • 1
    • 2
    • 3
  • Vito de Blasi
    • 1
    • 2
    • 3
  • Rene Adam
    • 4
  • Diane Goéré
    • 5
  • Alexis Laurent
    • 6
  • Nicola de’Angelis
    • 6
  • Tullio Piardi
    • 7
  • Emilie Lermite
    • 8
  • Astrid Herrero
    • 9
  • Francis Navarro
    • 9
  • Antonio Sa Cunha
    • 4
  • Patrick Pessaux
    • 1
    • 2
    • 3
    • 10
  • on behalf of the French colorectal liver metastases working group - Association Française de Chirurgie (AFC)
  1. 1.Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided SurgeryUniversité de StrasbourgStrasbourgFrance
  2. 2.Institut de Recherche Contre les Cancers de l’Appareil Digestif (IRCAD)StrasbourgFrance
  3. 3.General, Digestive, and Endocrine SurgeryNouvel Hôpital CivilStrasbourgFrance
  4. 4.Department of SurgeryHôpital Paul BrousseVillejuifFrance
  5. 5.Department of SurgeryInstitut Gustave RoussyVillejuifFrance
  6. 6.Department of SurgeryHôpital Henri MondorCréteilFrance
  7. 7.Department of SurgeryHôpital de Robert DebréReimsFrance
  8. 8.Department of SurgeryCentre Hospitalo-UniversitaireAngersFrance
  9. 9.Department of Digestive SurgeryHôpital Saint-EloiMontpellierFrance
  10. 10.StrasbourgFrance

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