Postoperative collections after liver surgery: predictors, and long-term outcomes

Abstract

Listen

Translate article

Introduction: Postoperative collection (PC) can occur after liver surgery (LS), but little is know on their impact on short and long-term outcomes. The aim of this study was to analyze factors predicting the occurrence of PC, the need of drainage and their impact on oncologic outcomes. Methods: . This prospective, single-center, cohort-study included all patients undergoing LS from 2008 to 2017. A systematic postoperative CT scan was realized on day7. The primary outcome was to determine variables associated with PC, defined as the presence of a fluid collection, and infected in case of positive bacterial culture. Secondary outcomes were to determine factors predicting drainage requirement, and the impact of infected PC on 5-y overall (OS) survival. Results: We included 254 patients: 45% (n=114) experienced PC. In the multivariate analysis, variables associated to PC occurrence were BMI (25-30=OR1.56(95%IC:0.78,3.13), 30-35=OR1.99(95%IC:0.67,5.89) p=0.002) and surgical resection (anatomic=reference, nonanatomic=OR1.22(95%IC:0.52,2.85), combined=OR2.09(95%IC:0.72,6.07), p=0.014). In the PC subgroup (n=114), variables predicting drainage requirement were antibiotic use OR14.01(95%CI:1.25,157 p= 0.015) and C-reactive protein (CRP) OR1.02(95%CI:1,1.05 p=0.043). The AUROC (0.71, 95%CI:0.59,0.83 p=0.002) found 152 mg/L as the optimal CRP cutoff value associated with PC drainage. In the malignant disease subgroup with PC (n=96), we observed lower 5-y OS among patients with infected vs non-infected PC (33% vs 56%, Log-Rank=0.03). Conclusions: In this cohort study we observed how nonanatomic or combined LS and BMI are associated to PC after LS, and those with CRP higher than 152 mg/L may require drainage. Moreover, the presence of an infected PC negatively impact 5-y OS.