title: Risk factors, management, and prognosis for liver abscess after radical resection of hilar cholangiocarcinoma.
abstract: OBJECTIVE
  Pyogenic liver abscess (PLA) is a rare but potentially lethal infectious complication after radical surgical resection of hilar cholangiocarcinoma (HC), this study is aimed to identify the risk factors, management and prognosis of PLA after curative surgical resection of HC.
  
  
  METHODS
  Between January 2003 and October 2013, 95 patients who underwent surgical resection of HC at a tertiary center were included in this study. The risk factors pertaining to PLA formation were identified by exact logistic regression.
  
  
  RESULTS
  PLA developed in 8 of 95 patients. The median duration of PLA formation following surgical procedure was 145 days (range, 16-295 days) and the most commonly isolated microorganism was Escherichia coli (4/8). Though most patients who developed PLA after surgery were successfully managed with antibiotics and invasive therapy, the overall survival was statistically poorer than those without PLA formation (median, 16.9 vs. 34.2 months, P=0.048). Univariate analysis revealed that coexisting biliary disorders (37.5% vs. 8.0%, P=0.036), vascular reconstruction (37.5% vs. 9.2%, P=0.041) and margin status (62.5% vs. 21.8%, P=0.023) were associated with PLA formation, whereas only vascular reconstruction (odds ratio (OR), 10.31; 95% confidence interval (CI), 1.03-142.73; P=0.047) and margin status (OR, 8.45; 95% CI, 1.13-109.38; P=0.035) were identified as independent risk factors by multivariate analysis.
  
  
  CONCLUSIONS
  Intraoperative vascular reconstruction and positive margin status pose greater risks for PLA formation after radical resection of HC. For patients with high risk factors, careful follow-up is needed for early detection and management of this infrequent complication.
authors.affiliation: Department of General Surgery, Qilu Hospital, Shandong UniversityJinan, China; Department of General Surgery, The Affiliated Hospital of Binzhou Medical CollegeBinzhou, China.
authors.forename: Changxi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of General Surgery, Qilu Hospital, Shandong University Jinan, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of General Surgery, Qilu Hospital, Shandong University Jinan, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of General Surgery, The Affiliated Hospital of Binzhou Medical College Binzhou, China.
authors.forename: Qiangpu
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of General Surgery, Qilu Hospital, Shandong University Jinan, China.
authors.forename: Xuting
authors.initials: X
authors.lastname: Zhi
keywords: Pyogenic liver abscess; complications; hilar cholangiocarcinoma; surgical treatment