title: Symptomatic Perihepatic Fluid Collections After Hepatic Resection in the Modern Era.
abstract: BACKGROUND
  Improvements in liver surgery have led to decreased mortality rates. Symptomatic perihepatic collections (SPHCs) requiring percutaneous drainage remain a significant source of morbidity.
  
  
  METHODS
  A single institution's prospectively maintained hepatic resection database was reviewed to identify patients who underwent hepatectomy between January 2004 and February 2012.
  
  
  RESULTS
  Data from 2173 hepatectomies performed in 2040 patients were reviewed. Overall, 200 (9%) patients developed an SPHC, the majority non-bilious (75.5%) and infected (54%). Major hepatic resections, larger than median blood loss (≥360 ml), use of surgical drains, and simultaneous performance of a colorectal procedure were associated with an SPHC on multivariate analysis. Non-bilious, non-infected (NBNI) collections were associated with lower white blood cell (WBC) counts, absence of a bilio-enteric anastomosis, use of hepatic arterial infusion pump (HAIP), and presence of metastatic disease, and resolved more frequently with a single interventional radiology (IR) procedure (85 vs. 46.5%, p < 0.001) more quickly (15 vs. 30 days, p = 0.001).
  
  
  CONCLUSIONS
  SPHCs developed in 9% of patients in a modern series of hepatic resections, and in one third were non-bilious and non-infected. In the era of modern interventional radiology, the need for re-operation for SPHC is exceedingly rare. A significant proportion of minimally symptomatic SPHC patients may not require drainage, and strategies to avoid unnecessary drainage are warranted.
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Ioannis T
authors.initials: IT
authors.lastname: Konstantinidis
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Mastrodomenico
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
authors.affiliation: Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: George I
authors.initials: GI
authors.lastname: Getrajdman
authors.affiliation: Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.affiliation: Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. dangelim@mskcc.org.|Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA. dangelim@mskcc.org.|Weill Cornell Medical College, New York, NY, USA. dangelim@mskcc.org.
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D001826:Body Fluids; D004322:Drainage / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007239:Infections / Q000150:complications; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D063189:Symptom Assessment; D055815:Young Adult
keywords: Hepatic resection; Interventional radiology drainage; Non-bilious, non-infected collections; Symptomatic perihepatic fluid collections