title: An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses larger than 5 cm.
abstract: OBJECTIVE
  To determine whether first-line treatment with percutaneous or surgical drainage of liver abscesses larger than 5 cm results in better clinical outcome.
  
  
  BACKGROUND
  Pyogenic liver abscesses larger than 5 cm are currently treated by intravenous antibiotics and either percutaneous (PD) or surgical drainage (SD). Percutaneous techniques have been increasingly performed in place of open drainage as first-line treatment. This paradigm shift has been fueled by the drive for low-risk and less-invasive procedures and the surgical option being reserved for percutaneous failures. Yet there is a lack of data to support percutaneous drainage over open surgical drainage as first-line treatment.
  
  
  METHODS
  Over a 3-year period, 80 patients with liver abscesses larger than 5 cm amenable to PD and SD were included in the study. This situation was possible as 1 team of surgeons favored the use of PD and 1 team favored the use of SD as first-line treatment. The treatment outcomes in both groups were compared, and clinical end-points included time to defervescence of fever, failure of treatment, secondary procedures, hospital stay, morbidity, and mortality.
  
  
  RESULTS
  PD was performed in 36 patients and SD in 44 patients as first-line treatment. Clinical, laboratory, and abscess parameters were comparable in both groups. Sixty-four of 80 patients (80%) had multiloculated abscess. The time to defervescence of fever was not statistically significant (PD versus SD, 4.85 versus 4.38 days; P = 0.09). However, SD had less treatment failures (3 versus 10, P = 0.013), less requirement for secondary procedures (5 versus 13, P = 0.01), and shorter length of hospital stay (8 versus 11 days, P = 0.03). There was no difference in morbidity or mortality rates.
  
  
  CONCLUSIONS
  The results of our study show that for large liver abscesses more than 5 cm, SD provides better clinical outcomes than PD in terms of treatment success, number of secondary procedures, and hospital stay with comparable morbidity and mortality rates. SD should be considered as first-line treatment of large liver abscesses.
authors.affiliation: From the Department of Surgery, Singapore General Hospital Department of Surgical Oncology, National Cancer Center, Singapore. gsutym@sgh.com.sg
authors.forename: Yu-Meng
authors.initials: YM
authors.lastname: Tan
authors.forename: Alexander Yaw-Fui
authors.initials: AY
authors.lastname: Chung
authors.forename: Pierce Kah-Hoe
authors.initials: PK
authors.lastname: Chow
authors.forename: Peng-Chung
authors.initials: PC
authors.lastname: Cheow
authors.forename: Wai-Keong
authors.initials: WK
authors.lastname: Wong
authors.forename: London Lucien
authors.initials: LL
authors.lastname: Ooi
authors.forename: Khee-Chee
authors.initials: KC
authors.lastname: Soo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011677:Punctures; D016896:Treatment Outcome
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