Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer.
BACKGROUND
The aim of this study was to identify predictors of treatment failure of percutaneous catheter drainage (PCD) in patients with hepatobiliary-pancreatic cancer with pyogenic liver abscess (PLA).


METHODS
Medical records of 44 patients with PLA with underlying hepatobiliary-pancreatic cancer who underwent PCD under computed tomographic guidance as primary treatment between January 2001 and December 2010 were collected and reviewed. Included patients were diagnosed with cholangiocarcinoma (n = 16), hepatocellular carcinoma (n = 12), pancreatic carcinoma (n = 9), carcinoma of the ampulla of Vater (n = 6), and gallbladder cancer (n = 1). The clinical factors related to failure of PCD were determined using logistic regression.


RESULTS
The median age of the 44 patients with PLA was 68 years, and 48% were men. PCD failed in 15 patients (34%). Of the 15 patients with PCD failure, 12 subsequently required surgical intervention because of either clinical deterioration or imaging that demonstrated failure of abscess resolution with PCD. Three of these patients died with the initial drain in place before resolution of the abscess. In patients requiring surgery after PCD failure, the frequency of cure or abscess resolution reached 67%. Fourteen patients (32%) died during hospitalization. Multivariate analysis identified that multiloculated abscesses (P = .005) and abscesses with biliary communication (P = .036) were associated with failure of PCD.


CONCLUSIONS
Multiloculated abscesses and lesions with biliary communication pose a greater likelihood of failure of PCD in patients with hepatobiliary-pancreatic cancer with PLA. Early surgical intervention after PCD failure should be considered for these patients.
Department of Surgery, China Medical University Beigang Hospital, Yunlin 65152, Taiwan.
Kuang-Chi
KC
Lai
Ken-Sheng
KS
Cheng
Long-Bin
LB
Jeng
Chi-Chou
CC
Huang
Yuan-Ti
YT
Lee
Horng-Rong
HR
Chang
Chun-Chieh
CC
Chen
Shiuan-Chih
SC
Chen
Meng-Chih
MC
Lee
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001661:Biliary Tract Neoplasms / Q000150:complications*; D002277:Carcinoma / Q000150:complications; D002406:Catheterization, Peripheral / Q000379:methods*; D002779:Cholestasis / Q000150:complications / Q000628:therapy; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000150:complications*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
D000900:Anti-Bacterial Agents