Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
Eur J Surg Oncol. 2019 Jun;45(6):1077-1083. doi: 10.1016/j.ejso.2019.02.021. Epub 2019 Feb 21.
Bile leakage (BL) is a frequent and severe complication following liver surgery. The aim of this study was to evaluate risk factors for BL, related other complications and association with long-term survival.
This study included all patients undergoing hepatectomy in a single centre from 2005 to 2016. Perioperative risk factors related to BL were identified using univariable and multivariable analysis. Kaplan-Meier method was used for survival analysis.
BL occurred in 48 of 458 patients (11%). BLs were more frequent in patients after major hepatectomy (p = 0.001). Portal vein embolization, bilioenteric-anastomosis, lymphadenectomy, vascular reconstruction and operative time were significant factors for developing BL. Comparing patients with or without BL, BL was more commonly associated with other postoperative complications (p = 0.001), especially acute kidney failure and surgical-site-infections. There was no difference in 90-day-mortality (p = 0.124). The median disease-free survival was comparable (17 vs. 15 months, p = 0.976), also no difference was observed when stratifying for different tumour entities. There was no difference in median overall survival (OS) among malignant disease (35 vs. 47 months, p = 0.200) and in 3-year OS (46% vs. 59%). Multivariate analysis confirmed that postoperative liver failure and major hepatectomy were risk factors for reduced OS (p = 0.010).
Many concerns have been raised regarding tumour progression after major complications. In this study, we only found a relevant influence of BL on OS in pCC, whereas no association was seen in other cancer types, indicating that tumour progression might be triggered by BL in cancer types arising from the bile ducts itself.
胆汁漏（BL）是肝手术后常见且严重的并发症。本研究旨在评估 BL 的相关危险因素、其他并发症及与长期生存的关系。
本研究纳入 2005 年至 2016 年期间在单中心行肝切除术的所有患者。采用单变量和多变量分析确定与 BL 相关的围手术期危险因素。采用 Kaplan-Meier 法进行生存分析。
458 例患者中有 48 例（11%）发生 BL。大范围肝切除患者 BL 发生率更高（p=0.001）。门静脉栓塞、胆肠吻合、淋巴结清扫、血管重建和手术时间是 BL 发生的显著因素。与无 BL 患者相比，BL 患者更常发生其他术后并发症（p=0.001），尤其是急性肾衰竭和手术部位感染。90 天死亡率无差异（p=0.124）。无瘤生存中位数无差异（17 个月 vs. 15 个月，p=0.976），不同肿瘤实体分层后亦无差异。恶性疾病的中位总生存（OS）无差异（35 个月 vs. 47 个月，p=0.200），3 年 OS 也无差异（46% vs. 59%）。多变量分析证实术后肝功能衰竭和大范围肝切除是 OS 降低的危险因素（p=0.010）。
人们对重大并发症后肿瘤进展存在诸多担忧。本研究仅发现 BL 对 pCC 的 OS 有相关影响，而在其他癌症类型中未见关联，提示 BL 可能在胆管本身来源的癌症类型中引发肿瘤进展。
