Analysis of Infectious Complications after Thermal Ablation of Hepatocellular Carcinoma and the Impact on Long-Term Survival

SIMPLE SUMMARY: Although thermal ablation has been widely used in treatments of HCC due to its unique advantages of less trauma, safety, postoperative complications still occur in clinical practice. Infectious complications are the third most common complication. The objective of our retrospective study was to summarize the clinical characteristics of infection after thermal ablation for HCC patients and to explore whether it affects tumor recurrence and overall survival. We enrolled 49 patients who developed postoperative infections and matched the same number of control patients, and we also summarized the clinical features and treatment of mild and severe infections. We found that postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. Empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection. ABSTRACT: Purpose: This study aims to complete a detailed record of the clinical characteristics and treatment of HCC patients with post-ablation infection and evaluate the infections on recurrence-free survival (RFS) and overall survival (OS) among patients receiving ultrasound-guided thermal ablation. Methods: 3117 patients with liver tumors receiving thermal ablation from January 2010 to December 2021 were analyzed. A total of 49 patients with infectious complications after thermal ablation were selected as the infection group. A total of 49 patients without postoperative infection were randomly selected among those who underwent ablation within three days before or after the treatment date of the infection group as the control group. The clinical characteristics of both groups were analyzed by an independent sample t-test and chi-square test. A log-rank test was performed to compare the RFS and OS data. A multivariate Cox regression model was employed to identify prognostic factors influencing RFS and OS. Subgroup analyses of mild and severe infections were conducted to explore the infection-related situation further. Results: Between mild and severe infection groups, there were statistically significant differences in the infection position (p = 0.043), positive rate of body fluid culture (p = 0.002), proportion of catheter drainage (p = 0.017), use of advanced antibiotics (p = 0.006), and outcome (p = 0.00). The Kaplan–Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence (p = 0.028), and severe infection was significantly associated with overall survival (p = 0.049). The cox model showed that postoperative infection was an independent variable for RFS deterioration (HR = 1.724, 95% CI: 1.038–2.862, p = 0.035). Conclusions: Postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. In addition, empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection.