Analysis of risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZOU Mengda , LI Changfeng , LIAO Yi , FENG Kai , MAO Guosong , XIA Feng , CHEN Zhiyu , ZHANG Leida ,  MA Kuansheng

Department of Hepatobiliary Surgery, The First Affiliated Hospital of Army Medical University, Chongqing 400038, P. R. China;

Corresponding author：

MA Kuansheng, Email: kuanshengma@outlook.com

Keywords：

choledochojejunostomy; metastatic hepatic carcinoma; radiofrequency ablation; postoperative infection

DOI：

10.7507/1007-9424.202205023

Video：

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Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.

Citation： ZOU Mengda, LI Changfeng, LIAO Yi, FENG Kai, MAO Guosong, XIA Feng, CHEN Zhiyu, ZHANG Leida, MA Kuansheng. Analysis of risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(9): 1143-1148. doi: 10.7507/1007-9424.202205023 Copy

1.	Michl M, Holtzem B, Koch J, et al. Metastatic colorectal cancer—analysis of treatment modalities and survival now and then. Dtsch Med Wochenschr, 2014, 139(41): 2068-2072.
2.	Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol, 2007, 25(29): 4575-4580.
3.	叶颖江, 申占龙, 王杉. 转移性肝癌的治疗理念和策略. 中华普外科手术学杂志(电子版), 2014, 8(1): 26-29.
4.	Tanis E, Nordlinger B, Mauer M, et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer, 2014, 50(5): 912-919.
5.	中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中华外科杂志, 2022, 60(4): 273-309.
6.	陈涛, 邢雪. 转移性肝癌的外科治疗进展. 临床普外科电子杂志, 2018, 6(1): 41-48.
7.	林淑芝, 徐倩, 武金玉, 等. 超声引导下经皮射频消融治疗恶性肿瘤肝转移. 中国介入影像与治疗学, 2018, 15(1): 29-32.
8.	Xu XL, Liu XD, Liang M, et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: Systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology, 2018, 287(2): 461-472.
9.	梁兴, 邵成浩. 胰十二指肠切除术后远期并发症诊治. 中国实用外科杂志, 2018, 38(7): 813-815,819.
10.	Chuang JH, Lee SY, Chen WJ, et al. Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: implication in the pathogenesis of postoperative cholangitis. World J Surg, 2001, 25(12): 1512-1518.
11.	Iida H, Aihara T, Ikuta S, et al. Risk of abscess formation after liver tumor radiofrequency ablation: a review of 8 cases wtih a history of enterobiliary anastomosis. Hepatogastroenterology, 2014, 61(135): 1867-1870.
12.	Shibata T, Yamamoto Y, Yamamoto N, et al. Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. J Vasc Interv Radiol, 2003, 14(12): 1535-1542.
13.	Fonseca AZ, Santin S, Gomes LG, et al. Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors. World J Hepatol, 2014, 6(3): 107-113.
14.	Elias D, Di Pietroantonio D, Gachot B, et al. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Gastroenterol Clin Biol, Jun-Jul 2006, 30(6-7): 823-827.
15.	Peterson JJ. Postoperative infection. Radiol Clin North Am, 2006, 44(3): 439-450.
16.	Hynes O, Anandavadivelan P, Gossage J, et al. The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer. Eur J Surg Oncol, 2017, 43(8): 1559-1565.
17.	Omata M, Tateishi R, Yoshida H, et al. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection therapy and radiofrequency ablation. Gastroenterology, 2004, 127(5 Suppl 1): S159-S166.
18.	李玉民, 马臻, 陈昊. 原发性肝癌射频消融治疗. 中华肝脏外科手术学电子杂志, 2017, 6(5): 337-342.
19.	Maeda M, Saeki I, Sakaida I, et al. Complications after radiofrequency ablation for hepatocellular carcinoma: A multicenter study involving 9 411 Japanese patients. Liver Cancer, 2020, 9(1): 50-62.
20.	Kasugai H, Osaki Y, Oka H, et al. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3 891 ablations in 2 614 patients. Oncology, 2007, 72 Suppl 1: 72-75.
21.	Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology, 2003, 226(2): 441-451.
22.	Choi D, Lim HK, Kim MJ, et al. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR Am J Roentgenol, 2005, 184(6): 1860-1867.
23.	孙阿妮, 刘燕, 于凌波. 肝脏肿瘤患者射频消融术后肝内感染的危险因素分析. 中华医院感染学杂志, 2015, 25(21): 4947-4948, 4951.
24.	Nam SY, Rhim H, Kang TW, et al. Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm: clinical assessment of the heat-sink effect of artificial ascites. AJR Am J Roentgenol, 2010, 194(2): W227-W231.
25.	尹刚, 朱卫华, 阿民布和, 等. 肝脏恶性肿瘤消融术后感染的影响因素. 中国老年学杂志, 2021, 41(3): 504-506.
26.	Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology, 1988, 166(2): 381-387.
27.	Geschwind JF, Kaushik S, Ramsey DE, et al. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol, 2002, 13(11): 1163-1166.
28.	Kim W, Clark TW, Baum RA, et al. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol, 2001, 12(8): 965-968.

1. Michl M, Holtzem B, Koch J, et al. Metastatic colorectal cancer—analysis of treatment modalities and survival now and then. Dtsch Med Wochenschr, 2014, 139(41): 2068-2072.
2. Tomlinson JS, Jarnagin WR, DeMatteo RP, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol, 2007, 25(29): 4575-4580.
3. 叶颖江, 申占龙, 王杉. 转移性肝癌的治疗理念和策略. 中华普外科手术学杂志(电子版), 2014, 8(1): 26-29.
4. Tanis E, Nordlinger B, Mauer M, et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer, 2014, 50(5): 912-919.
5. 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗指南(2022年版). 中华外科杂志, 2022, 60(4): 273-309.
6. 陈涛, 邢雪. 转移性肝癌的外科治疗进展. 临床普外科电子杂志, 2018, 6(1): 41-48.
7. 林淑芝, 徐倩, 武金玉, 等. 超声引导下经皮射频消融治疗恶性肿瘤肝转移. 中国介入影像与治疗学, 2018, 15(1): 29-32.
8. Xu XL, Liu XD, Liang M, et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma: Systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology, 2018, 287(2): 461-472.
9. 梁兴, 邵成浩. 胰十二指肠切除术后远期并发症诊治. 中国实用外科杂志, 2018, 38(7): 813-815,819.
10. Chuang JH, Lee SY, Chen WJ, et al. Changes in bacterial concentration in the liver correlate with that in the hepaticojejunostomy after bile duct reconstruction: implication in the pathogenesis of postoperative cholangitis. World J Surg, 2001, 25(12): 1512-1518.
11. Iida H, Aihara T, Ikuta S, et al. Risk of abscess formation after liver tumor radiofrequency ablation: a review of 8 cases wtih a history of enterobiliary anastomosis. Hepatogastroenterology, 2014, 61(135): 1867-1870.
12. Shibata T, Yamamoto Y, Yamamoto N, et al. Cholangitis and liver abscess after percutaneous ablation therapy for liver tumors: incidence and risk factors. J Vasc Interv Radiol, 2003, 14(12): 1535-1542.
13. Fonseca AZ, Santin S, Gomes LG, et al. Complications of radiofrequency ablation of hepatic tumors: Frequency and risk factors. World J Hepatol, 2014, 6(3): 107-113.
14. Elias D, Di Pietroantonio D, Gachot B, et al. Liver abscess after radiofrequency ablation of tumors in patients with a biliary tract procedure. Gastroenterol Clin Biol, Jun-Jul 2006, 30(6-7): 823-827.
15. Peterson JJ. Postoperative infection. Radiol Clin North Am, 2006, 44(3): 439-450.
16. Hynes O, Anandavadivelan P, Gossage J, et al. The impact of pre- and post-operative weight loss and body mass index on prognosis in patients with oesophageal cancer. Eur J Surg Oncol, 2017, 43(8): 1559-1565.
17. Omata M, Tateishi R, Yoshida H, et al. Treatment of hepatocellular carcinoma by percutaneous tumor ablation methods: Ethanol injection therapy and radiofrequency ablation. Gastroenterology, 2004, 127(5 Suppl 1): S159-S166.
18. 李玉民, 马臻, 陈昊. 原发性肝癌射频消融治疗. 中华肝脏外科手术学电子杂志, 2017, 6(5): 337-342.
19. Maeda M, Saeki I, Sakaida I, et al. Complications after radiofrequency ablation for hepatocellular carcinoma: A multicenter study involving 9 411 Japanese patients. Liver Cancer, 2020, 9(1): 50-62.
20. Kasugai H, Osaki Y, Oka H, et al. Severe complications of radiofrequency ablation therapy for hepatocellular carcinoma: an analysis of 3 891 ablations in 2 614 patients. Oncology, 2007, 72 Suppl 1: 72-75.
21. Livraghi T, Solbiati L, Meloni MF, et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology, 2003, 226(2): 441-451.
22. Choi D, Lim HK, Kim MJ, et al. Liver abscess after percutaneous radiofrequency ablation for hepatocellular carcinomas: frequency and risk factors. AJR Am J Roentgenol, 2005, 184(6): 1860-1867.
23. 孙阿妮, 刘燕, 于凌波. 肝脏肿瘤患者射频消融术后肝内感染的危险因素分析. 中华医院感染学杂志, 2015, 25(21): 4947-4948, 4951.
24. Nam SY, Rhim H, Kang TW, et al. Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm: clinical assessment of the heat-sink effect of artificial ascites. AJR Am J Roentgenol, 2010, 194(2): W227-W231.
25. 尹刚, 朱卫华, 阿民布和, 等. 肝脏恶性肿瘤消融术后感染的影响因素. 中国老年学杂志, 2021, 41(3): 504-506.
26. Spies JB, Rosen RJ, Lebowitz AS. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology, 1988, 166(2): 381-387.
27. Geschwind JF, Kaushik S, Ramsey DE, et al. Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors. J Vasc Interv Radiol, 2002, 13(11): 1163-1166.
28. Kim W, Clark TW, Baum RA, et al. Risk factors for liver abscess formation after hepatic chemoembolization. J Vasc Interv Radiol, 2001, 12(8): 965-968.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy

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