Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma.
OBJECTIVE
Bile leakage after hepatic resection can cause septic complications and mortality. This study evaluated the risk factors associated with postoperative bile leakage in hepatocellular carcinoma patients.


METHODS
Between July 1991 and December 2000, 605 consecutive hepatocellular carcinoma patients who underwent hepatic resection were enrolled. Risk factors associated with postoperative bile leakage were examined, with 38 clinicopathological variables being analyzed. Data were collected prospectively and analyzed retrospectively.


RESULTS
Bile leakage developed in 35 (5.8%) of 605 patients. When compared with patients without bile leakage, those with bile leakage had higher risk for concomitant morbidities (54.3% vs. 29.2%, P=0.002), postoperative mortality (8.6% vs. 2.6%, P=0.045), and a prolonged postoperative hospital stay (29 days vs. 14 days, P<0.001). The bile leakage rate of centrally located tumors (9.4%) was significantly higher than that of peripherally located tumors (3.5%; P=0.002). The bile leakage rate of patients with preoperative chemoembolization (13.8%) was significantly higher than those without chemoembolization (4.9%; P=0.004). Stepwise logistic regression analysis identified preoperative chemoembolization (OR=3.274, P=0.005) and tumor(s) being centrally located (OR=2.927, P=0.003) as the independent predictors of development of bile leakage.


CONCLUSIONS
For HCC patients, preoperative chemoembolization and tumor(s) with central location are risk factors for post-hepatectomy bile leakage. As bile leakage can cause septic complications and liver failure, careful surgical procedures and use of preventive measures are necessary, especially in patients with high risk factors.
Department of Surgery, Taipei Veterans General Hospital, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chih-Chun
CC
Lee
Gar-Yang
GY
Chau
Wing-Yiu
WY
Lui
Shyh-Haw
SH
Tsay
Kuang-Liang
KL
King
Che-Chuan
CC
Loong
Cheng-Yuan
CY
Hsia
Chew-Wun
CW
Wu
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001646:Bile; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin