Predictive factors for bile leakage after hepatectomy for hepatic tumors: a retrospective multicenter study with 631 cases at Yokohama Clinical Oncology Group (YCOG).
BACKGROUND
International Study Group of Liver Surgery (ISGLS) proposed the standardized definition for bile leakage (BL) after hepatectomy (Hx) at 2011 to precisely perceive incidence and predictive factors of this critical condition.


METHODS
We conducted a multicenter retrospective study using the ISGLS definition of BL after Hx.


RESULTS
Perioperative data regarding 631 patients undergoing elective Hx for hepatic tumors without biliary reconstruction performed between January 2009 and December 2011 were analyzed. BL was observed in 30 patients (4.8%). (Grade A, 8 (1.3%); B, 21(3.3%); C, 1 (0.2%)). Five independent predictors (diagnosis of liver metastases, prolonged operation, high risk procedures defined as Hx with broad exposure of the hilar Glissonean sheath, low platelet count and high serum total bilirubin on postoperative day 1) for grade B/C BL were elucidated by the multivariate analysis. When the study cohorts were divided into groups by number of accompanying these predictors, the more the accompanying independent predictors, the higher the incidence of BL. Notably, incidence of BL exceeded 40% in patients with four or more of these predictors.


CONCLUSIONS
Risk stratification for BL after Hx can be achievable using independent predictors clarified in this study. However, proper management for high risk patients remains to be elucidated.
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Kazuya
K
Nakagawa
Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan.
Kuniya
K
Tanaka
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Kazunori
K
Nojiri
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Yu
Y
Sawada
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Takafumi
T
Kumamoto
Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
Michio
M
Ueda
Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan.
Yuta
Y
Minami
Department of Surgery, Yokohama City Hospital, Yokohama, Japan.
Yasuhisa
Y
Mochizuki
Department of Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan.
Daisuke
D
Morioka
Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan.
Toru
T
Kubota
Department of Surgery, Ito Municipal Hospital, Ito, Japan.
Noriyuki
N
Kamiya
Department of Surgery, Saiseikai Wakakusa Hospital, Yokohama, Japan.
Kenichi
K
Yoshida
Department of Biostatistics, Center for Novel and Exploratory Clinical Trials, Yokohama City University, Yokohama, Japan.
Naohiro
N
Yonemoto
Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Itaru
I
Endo
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000175:diagnosis / Q000453:epidemiology*; D001652:Bile Ducts / Q000503:physiopathology / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
Bile leakage; Hepatectomy; Hepatic tumors; Risk factor