Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Hepatobiliary Pancreat Sci. 2020 Dec;27(12):931-941. doi: 10.1002/jhbp.750. Epub 2020 Jun 3.
BACKGROUND/PURPOSE: The incidence of bile leakage after liver resection for hepatocellular carcinoma (HCC) remains a cause for concern. There are limited reports on the impacts of postoperative bile leakage on long-term clinical outcomes. This study aims to evaluate the effects of postoperative bile leakage on recurrence-free survival (RFS) and overall survival (OS).
A total of 1,178 patients who underwent curative liver resection for HCC between 1986 and 2012 were included in the present study. Postoperative bile leakage was defined using the International Study Group of Liver Surgery definition, and the primary end points of the study were OS and RFS at 5 years.
Forty-three (3.7%) patients had bile leakage following liver resection. The median follow-up was 5 years. A follow-up analysis revealed that patients with bile leakage had poor 5-year rates of OS (41.0% vs 56.4%, P = .013) and RFS (14.6% vs 28.7%, P < .001). Additionally, bile leakage was an independent factor for both OS [hazard ratio (HR) 1.559, P = .022] and RFS (HR 1.517, P = .024). Furthermore, bile leakage was the only factor affecting prognosis among postoperative complications.
Postoperative bile leakage worsens long-term clinical outcomes following liver resection in HCC patients.
背景/目的：肝癌（HCC）肝切除术后胆漏的发生率仍然令人担忧。关于术后胆漏对长期临床结果的影响的报告有限。本研究旨在评估术后胆漏对无复发生存（RFS）和总生存（OS）的影响。
本研究共纳入 1986 年至 2012 年间接受根治性肝切除术治疗 HCC 的 1178 例患者。术后胆漏采用国际肝脏外科研究组的定义，研究的主要终点为 5 年 OS 和 RFS。
43 例（3.7%）患者在肝切除术后发生胆漏。中位随访时间为 5 年。随访分析显示，胆漏患者的 5 年 OS 率（41.0%比 56.4%，P=.013）和 RFS 率（14.6%比 28.7%，P<.001）较差。此外，胆漏是 OS（风险比 [HR] 1.559，P=.022）和 RFS（HR 1.517，P=.024）的独立因素。此外，胆漏是术后并发症中唯一影响预后的因素。
肝癌肝切除术后胆漏可使患者长期临床结果恶化。
