Risk factors for bile leakage: Latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database.
bile leakage
hepatic resections
hepatocellular carcinoma
risk factors
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
revised:
11
08
2020
received:
14
06
2020
accepted:
18
08
2020
pubmed:
9
9
2020
medline:
16
10
2021
entrez:
8
9
2020
Statut:
ppublish
Résumé
The aim of this study was to identify risk factors for bile leakage in hepatic resections without biliary reconstructions using the large Japanese national clinical database (NCD). A total of 10 102 patients who had undergone hepatic resection involving more than one segment without biliary reconstructions for hepatocellular carcinoma during 2015-2017 were enrolled. Risk factors for bile leakage, with special reference to the type of hepatic resection, were identified by multivariable logistic regression analysis. Bile leakage occurred in 726 patients (7.2%). Risk factors for bile leakage were as follows: male sex (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.04-1.58), diabetes mellitus (+) (OR 1.19, 95% CI 1.01-1.39), hemoglobin <10 g/dL (OR 1.4, 95% CI 1.02-1.93), albumin <3.5 g/dL (OR 1.3, 95% CI 1.03-1.63), central bisectionectomy (OR 3.8, 95% CI 2.81-5.13), left trisectionectomy (OR 3.6, 95% CI 2.10-6.15), right anterior sectionectomy (OR 2.07, 95% CI 1.58-2.72), and S5 or S8 segmentectomy (OR 1.33, 95% CI 1.00-1.77). Central bisectionectomy, left trisectionectomy, and right anterior sectionectomy are high-risk types of hepatic resection for bile leakage.
Sections du résumé
BACKGROUND/PURPOSE
OBJECTIVE
The aim of this study was to identify risk factors for bile leakage in hepatic resections without biliary reconstructions using the large Japanese national clinical database (NCD).
METHODS
METHODS
A total of 10 102 patients who had undergone hepatic resection involving more than one segment without biliary reconstructions for hepatocellular carcinoma during 2015-2017 were enrolled. Risk factors for bile leakage, with special reference to the type of hepatic resection, were identified by multivariable logistic regression analysis.
RESULTS
RESULTS
Bile leakage occurred in 726 patients (7.2%). Risk factors for bile leakage were as follows: male sex (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.04-1.58), diabetes mellitus (+) (OR 1.19, 95% CI 1.01-1.39), hemoglobin <10 g/dL (OR 1.4, 95% CI 1.02-1.93), albumin <3.5 g/dL (OR 1.3, 95% CI 1.03-1.63), central bisectionectomy (OR 3.8, 95% CI 2.81-5.13), left trisectionectomy (OR 3.6, 95% CI 2.10-6.15), right anterior sectionectomy (OR 2.07, 95% CI 1.58-2.72), and S5 or S8 segmentectomy (OR 1.33, 95% CI 1.00-1.77).
CONCLUSION
CONCLUSIONS
Central bisectionectomy, left trisectionectomy, and right anterior sectionectomy are high-risk types of hepatic resection for bile leakage.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
556-562Subventions
Organisme : Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS)
Informations de copyright
© 2020 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Références
Taketomi A, Kitagawa D, Itoh S, Harimoto N, Yamashita Y, Gion T, et al. Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute's experience with 625 patients. J Am Coll Surg. 2007;204:580-7.
Yamashita Y, Tsuijita E, Takeishi K, Ishida T, Ikegami T, Ezaki T, et al. Trends in surgical results of hepatic resection for hepatocellular carcinoma: 1,000 consecutive cases over 20 years in a single institution. Am J Surg. 2014;207:890-6.
Guillaud A, Pery C, Campillo B, Lourdais A, Sulpice L, Boudjema K. Incidence and predictive factors of clinically relevant bile leakage in the modern era of liver resections. HPB (Oxford). 2013;15:224-9.
Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al. Bile leakage after hepatic resection. Ann Surg. 2001;233:45-50.
Capussotti L, Ferrero A, Viganò L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: where is the risk? Arch Surg. 2006;141:690-4; discussion 695.
Lee CC, Chau GY, Lui WY, Tsay SH, King KL, Loong CC, et al. Risk factors associated with bile leakage after hepatic resection for hepatocellular carcinoma. Hepatogastroenterology. 2005;52:1168-71.
Viganò L, Ferrero A, Sgotto E, Tesoriere RL, Calgaro M, Capussotti L. Bile leak after hepatectomy: predictive factors of spontaneous healing. Am J Surg. 2008;196:195-200.
Kajiwara T, Midorikawa Y, Yamazaki S, Higaki T, Nakayama H, Moriguchi M, et al. Clinical score to predict the risk of bile leakage after liver resection. BMC Surg. 2016;16:30.
Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Yamamoto J. Predictive factors for bile leakage after hepatectomy: analysis of 505 consecutive patients. World J Surg. 2011;35:1898-903.
Panaro F, Hacina L, Bouyabrine H, Al-Hashmi AW, Herrero A, Navarro F. Risk factors for postoperative bile leakage: a retrospective single-center analysis of 411hepatectomies. Hepatobiliary Pancreat Dis Int. 2016;15:81-6.
Tanaka S, Hirohashi K, Tanaka H, Shuto T, Lee SH, Kubo S, et al. Incidence and management of bile leakage after hepatic resection for malignant hepatic tumors. J Am Coll Surg. 2002;195:484-9.
Sadamori H, Yagi T, Matsuda H, Shinoura S, Umeda Y, Fujiwara T. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases. Dig Surg. 2012;29:149-56.
Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg. 1998;133:156-61.
Nagano Y, Togo S, Tanaka K, Masui H, Endo I, Sekido H, et al. Risk factors and management of bile leakage after hepatic resection. World J Surg. 2003;27:695-8.
Ishii H, Ochiai T, Murayama Y, Komatsu S, Shiozaki A, Kuriu Y, et al. Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis. Dig Surg. 2011;28:198-204.
Andersson R, Tranberg KG, Bengmark S. Roles of bile and bacteria in biliary peritonitis. Br J Surg. 1990;77:36-9.
Andersson R, Schalén C, Tranberg KG. Effect of bile on growth, peritoneal absorption, and blood clearance of Escherichia coli in E. coli peritonitis. Arch Surg. 1991;126:773-7.
Yanaga K, Kanematsu T, Takenaka K, Sugimachi K. Intraperitoneal septic complications after hepatectomy. Ann Surg. 1986;203:148-52.
Miura F, Yamamoto M, Gotoh M, Konno H, Fujimoto J, Yanaga K, et al. Validation of the board certification system for expert surgeons (hepato-biliary-pancreatic field) using the data of the National Clinical Database of Japan: part 1 - Hepatectomy of more than one segment. J Hepatobiliary Pancreat Sci. 2016;23:313-23.
Kakeji Y, Takahashi A, Udagawa H, Unno M, Endo I, Kunisaki C, et al. Surgical outcomes in gastroenterological surgery in Japan: Report of National Clinical database 2011-2016. Ann Gastroenterol Surg. 2017;2:37-54.
Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149:680-8.
Kubota K, Aoki T, Kumamaru H, Shiraki T, Miyata H, Seto Y, et al. Use of the National Clinical Database to evaluate the association between preoperative liver function and postoperative complications among patients undergoing hepatectomy. J Hepatobiliary Pancreat Sci. 2019;26:331-40.
Ito A, Ebata T, Yokoyama Y, Igami T, Mizuno T, Yamaguchi J, et al. Ethanol ablation for refractory bile leakage after complex hepatectomy. Br J Surg. 2018;105:1036-43.
Hong J, Zhang X, Luo R, Cai X. The clinical risk factors associated with postoperative bile leakage after hepatectomy: a meta-analysis. Minerva Med. 2016;107:39-53.
Sato F, Igami T, Ebata T, Yokoyama Y, Sugawara G, Mizuno T, et al. A study of the right intersectional plane (right portal scissura) of the liver based on virtual lefthepatic trisectionectomy. World J Surg. 2014;38:3181-5.
Otsubo T, Kobayashi S, Sano K, Misawa T, Ota T, Katagiri S, et al. Safety-related outcomes of the Japanese Society of Hepato-Biliary-Pancreatic Surgery board certification system for expert surgeons. J Hepatobiliary Pancreat Sci. 2017;24:252-61.
Linke R, Ulrich F, Bechstein WO, Schnitzbauer AA. The White-test helps to reduce biliary leakage in liver resection: a systematic review and meta-analysis. Ann Hepatol. 2015;14:161-7.
Wang HQ, Yang J, Yang JY, Yan LN. Bile leakage test in liver resection: a systematic review and meta-analysis. World J Gastroenterol. 2013;19:8420-6.
Nanashima A, Abo T, Shibuya A, Tominaga T, Matsumoto A, Tou K, et al. Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak? HPB (Oxford). 2013;15:517-22.
Kubo N, Shirabe K. Treatment strategy for isolated bile leakage after hepatectomy: literature review. Ann Gastroenterol Surg. 2019;4:47-55.
Erdogan D, Busch OR, Gouma DJ, van Gulik TM. Prevention of biliary leakage after partial liver resection using topical hemostatic agents. Dig Surg. 2007;24:294-9.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-96.