title: Infectious complications after gastric cancer surgery accelerate a rapid hepatic recurrence.
abstract: OBJECTIVE
  Rapid hepatic recurrence is sometimes experienced after gastric or pancreatobiliary cancer surgery. The aim of this study was to investigate the risk factors for the timing of hepatic recurrence.
  
  
  METHODS
  The medical records of 20 patients who had hepatic recurrence after either a gastrectomy for gastric cancer (11 patients) or a pancreatoduodenectomy for pancreatobiliary cancer (9 patients) between 2002 and 2007 were retrospectively reviewed. The cumulative recurrence rate of liver metastasis was calculated using the Kaplan-Meier method, and 14 possible factors affecting the rapid hepatic recurrence were analyzed by univariate and multivariate analyses.
  
  
  RESULTS
  The median time for the hepatic recurrence after the operation was 4.9 months (range 1 to 20.4 months). Among 14 factors, only postoperative infectious complications significantly accelerated the hepatic recurrence based on a univariate analysis (p = 0.049). Two more factors, gastric cancer and preoperative tumor marker elevation, had a tendency to affect the rapid recurrence, but did not show statistical significance (both p = 0.06). A multivariate analysis revealed that postoperative infectious complications (p = 0.005) and gastric cancer (p = 0.04) were significant and independent factors. Five of 11 patients with gastric cancer suffered from postoperative infectious complications, 4 of which were associated with pancreatic leakage after a pancreatosplenectomy, and all 5 patients had hepatic recurrence within 3 months after the operation.
  
  
  CONCLUSIONS
  Postoperative infectious complications are thus considered to accelerate a rapid hepatic recurrence after a gastrectomy for gastric cancer.
authors: Department of Surgery, Saga University Faculty of Medicine, Saga, Japan. ootsuka4@cc.saga-u.ac.jp
authors: Takao
authors: T
authors: Ohtsuka
authors: Yoshihiko
authors: Y
authors: Kitajima
authors: Tomohide
authors: T
authors: Takahashi
authors: Seiji
authors: S
authors: Sato
authors: Atsushi
authors: A
authors: Miyoshi
authors: Naohiho
authors: N
authors: Kohya
authors: Kenji
authors: K
authors: Kitahara
authors: Yuji
authors: Y
authors: Nakafusa
authors: Kohji
authors: K
authors: Miyazaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000150:complications*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
chemical_list: D014409:Tumor Necrosis Factor-alpha