Impact of concurrent primary colorectal resection on postoperative infectious complications following hepatic thermal ablation for colorectal liver metastases: an ACS-NSQIP analysis.

Background

Surgical management of colorectal liver metastases (CRLM) often involves multi-organ interventions which elevate postoperative infectious risk. While thermal ablation is increasingly used as a parenchymal-sparing strategy, infectious risk when combined with colorectal resection is unclear.

Methods

Adults in the ACS-NSQIP database (2020-2023) undergoing hepatic thermal ablation, hepatic resection, or colorectal resection for CRLM were identified. The primary outcome was 30-day hepatic abscess, derived from organ-space infection excluding anastomotic leaks. Multivariable logistic regression assessed the impact of concurrent colorectal resection. Propensity score-matched and exploratory analyses compared infectious outcomes across procedure combinations.

Results

Among 660 patients (median age 59, 58% male), 52% underwent concurrent colorectal resection, with more transfusions, myocardial infarctions, reoperations, and longer hospital stays. In matched analysis, adding hepatic ablation to colorectal resection was independently associated with hepatic abscess, wound complications, and serious complications (OR 9.70, 4.88, 3.77, respectively). Conversely, concurrent colorectal resection and ablation increased infectious morbidity compared to ablation alone. Ablation alone demonstrated lower infectious risk than hepatic resection; concurrent colorectal surgery increased morbidity regardless of hepatic procedure.

Discussion

Concurrent colorectal resection with hepatic thermal ablation for CRLM increases infectious morbidity. While ablation alone maintains a favorable infectious profile, bowel manipulation appears to drive elevated risk.