Infections and Infections and Spectrum of Pathogens in Patients with Malignant Tumors of the Liver and Biliary Tract with Biliary Obstruction after Extensive Liver Resections

A malignant tumor is an independent risk factor for the development of surgical site infections (SSIs), and the risk of postoperative complications in patients is 3 times higher than in patients without a malignant process. Unfortunately, even with perfect adherence to the rules of asepsis and antiseptics, the contamination of the surgical wound is inevitable during surgery. In patients with malignant liver tumors the infection can be caused by malignant obstruction, bile stasis, preoperative manipulations of the biliary tract (drainage or stenting). The objective: to analyze the spectrum of bacterial infections and their pathogens in patients with primary malignant tumors of the liver and biliary tract with obstruction of the biliary tract compared to patients without obstruction of the biliary tract after extended liver resections (ELRs). Materials and methods. 70 statistically homogeneous patients in terms of age and gender took part in the study: 32 persons with hepatocellular carcinoma (HCC) and 38 persons with cholangiocarcinoma (CC). Patients were divided into groups. The 1st (main one) group included 35 patients with primary liver tumors after ELRs with biliary obstruction, the 2nd (control one) group included 35 patients with primary liver tumors after ELRs without biliary obstruction. The age of the patients was 61.2 ± 10.7 years and 64.5 ± 11.4 years, respectively. Objective data, laboratory and instrumental examinations were used to establish the diagnosis and complications that occurred in patients after surgery. Results. In patients with HCC and CC with biliary obstruction after ELRs (main group) the infectious complications occurred in 100% of cases, versus to patients with HCC and CC without biliary obstruction (control group). Opportunistic microorganisms, which were represented by a sufficiently wide spectrum of gram-negative and gram-positive bacteria, were determined in patients after ELRs. Pneumonia (17.1% of cases), cholangitis (14.3%), SSIs (28.6%), SSIs com bined with cholangitis (11.4%), and SSIs in combination with infections of the central circulation (11.4%) were significantly more common in patients with HCC and CC with biliary obstruction after ELRs. Conclusions. The results of the study should be used to develop a strategy to reduce postoperative bacterial complications and additional financial costs after ELRs in the future.