title: Liver Resection for De Novo Hepatocellular Carcinoma Complicated by Pyogenic Liver Abscess: A Clinical Challenge.
abstract: BACKGROUND
  De novo hepatocellular carcinoma (HCC) complicated by pyogenic liver abscess is rare, and the standard of care for this disease has yet been defined. This study assesses whether liver resection can be recommended as its standard treatment.
  
  
  METHODS
  This retrospective study reviewed the prospectively collected data of the 1725 patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2012. Outcomes were compared between patients with and without liver abscess.
  
  
  RESULTS
  Twenty-two (1.28 %) patients had HCC and liver abscess. Fourteen of them received preoperative drainage. Patients with and without abscess had similar tumor characteristics, but patients with abscess had more operative blood loss (2.2 vs. 0.8 L; p < 0.0001) and more of them needed blood transfusion (63.6 vs. 23.1 %; p < 0.0001). They also had a longer hospital stay (38.5 vs. 10 days; p < 0.0001), a higher hospital mortality (40.9 vs. 2.8 %; p < 0.001), a higher postoperative complication rate (100 vs. 25.9 %; p < 0.0001), and poorer 1, 3, and 5-years disease-free survival rates (p = 0.023).
  
  
  CONCLUSIONS
  The post-resection mortality of the patients with de novo HCC complicated by pyogenic liver abscess was so high that liver resection is not recommended as the standard treatment. More research is needed to determine the best therapy for this rare disease.
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. kennethchok@gmail.com.
authors: Kenneth S H
authors: KS
authors: Chok
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors: Tan To
authors: TT
authors: Cheung
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors: Albert C Y
authors: AC
authors: Chan
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors: Wing Chiu
authors: WC
authors: Dai
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors: See Ching
authors: SC
authors: Chan
authors: Department of Surgery, Queen Mary Hospital, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China.
authors: Chung Mau
authors: CM
authors: Lo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D046290:Liver Abscess, Pyogenic / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D055815:Young Adult