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Infectious complications of hepatic cryosurgery
D K Riley1, T J Babinchak, R Zemel
1Department of Medicine, Allegheny General Hospital, Medical College of Pennsylvania, and Hahnemann University, Pittsburgh, 15212, USA.
Abstract:
Hepatic cryosurgery is a novel procedure for patients with metastatic liver disease. To date, no reviews of the infectious complications of this procedure have been published. One hundred and fifty patients underwent 158 hepatic cryosurgical procedures at Allegheny General Hospital (Pittsburgh) from November 1987 through July 1995. Gastrointestinal malignancies accounted for 93% of the underlying diagnoses. The following 12 infections were directly related to the cryosurgical procedure: hepatic abscess (six), intraperitoneal abscess (three), ascending cholangitis (two), and an intrahepatic device (Infusaid; Strato/Infusoid, Norwood, MA) infection (one). Enterococcus was the most commonly isolated organism. Seven of the 12 infections were polymicrobial. The patients who developed infections had longer hospital stays (26 days vs. 13 days) and had more days of fever (6.5 days vs. 2.3 days). than those who did not develop infections. If perioperative manipulation of the biliary tree is avoided, the infection rate in patients who undergo hepatic cryosurgery may be decreased even further. Overall, cryoablation of the liver is not related to an increased risk of infection.
Insights
Hepatic cryosurgery for liver metastases can cause infections like abscesses and cholangitis, primarily linked to gastrointestinal cancers. Avoiding biliary tree manipulation may reduce these risks, with overall cryoablation not increasing infection risk.
Area of Science:
- Hepatobiliary Surgery
- Interventional Radiology
- Oncology
Background:
- Hepatic cryosurgery is an emerging treatment for liver metastases.
- Infectious complications of this procedure have not been previously reviewed.
- Gastrointestinal malignancies are the primary indication for hepatic cryosurgery.
Purpose of the Study:
- To review and analyze infectious complications following hepatic cryosurgery.
- To identify common pathogens and risk factors associated with these infections.
- To evaluate the overall infection risk associated with liver cryoablation.
Main Methods:
- Retrospective review of 158 hepatic cryosurgical procedures performed between November 1987 and July 1995.
- Analysis of patient data, including diagnoses, procedures, and post-operative outcomes.
- Identification and categorization of all directly related infectious complications.
Main Results:
- Twelve infectious complications were directly attributed to hepatic cryosurgery.
- Common infections included hepatic abscess (6), intraperitoneal abscess (3), and ascending cholangitis (2).
- Enterococcus was the most frequent organism isolated, with 7 infections being polymicrobial.
Conclusions:
- Hepatic cryosurgery can lead to specific infectious complications, notably abscesses and cholangitis.
- Patients experiencing infections had significantly longer hospital stays and more febrile days.
- Minimizing perioperative biliary tree manipulation may further decrease infection rates; overall cryoablation does not elevate infection risk.