title: Negative impact of surgical site infection on long-term outcomes after hepatic resection for colorectal liver metastases.
abstract: BACKGROUND
  Postoperative infectious complications are associated with a poor long-term prognosis after resection of malignant tumors. We hypothesized that postoperative infectious complication such as surgical site infection (SSI) may have a negative impact on the outcome of elective hepatic resection for colorectal liver metastases (CRLM), and that the Glasgow prognostic score (GPS), which reflects the systemic inflammatory response, might predict for such complications.
  
  
  METHODS
  The subjects of the study were 77 patients who underwent hepatic resection for CRLM between January 2000 and December 2009. We retrospectively investigated the relation between SSI and disease-free, as well as overall, survival. Moreover, we assessed the risk factors pertinent to SSI.
  
  
  RESULTS
  In multivariate analysis, having more than four lymph node metastases (p=0.015) was a significant predictor of disease-free survival, while significant predictors of overall survival were the presence of more than four lymph node metastases (p=0.001) and SSI (p=0.008). Moreover, bilobar distribution (p=0.026), intraoperative fresh-frozen plasma transfusion (p=0.036) and GPS 1 or 2 (p=0.023) were found to be independent risk factors for SSI.
  
  
  CONCLUSIONS
  Development of SSI after elective hepatic resection is associated with worse long-term outcomes in patients with CRLM. The GPS may be useful for preoperative risk stratification of SSI in such patients.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. haruki@jikei.ac.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.forename: Shigeki
authors.initials: S
authors.lastname: Wakiyama
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ogawa
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ishida
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D015179:Colorectal Neoplasms / Q000382:microbiology / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D007239:Infections / Q000209:etiology* / Q000601:surgery; D008113:Liver Neoplasms / Q000382:microbiology / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors