Gastrointestinal Surgery Center, Department of Surgery, Faculty of Medicine, Mansoura University, Gehan Street, Mansoura, 35516, Egypt.
J Gastrointest Surg. 2022 Oct;26(10):2070-2081. doi: 10.1007/s11605-022-05433-7. Epub 2022 Aug 24.
Bile leakage (BL) is one of the commonest morbidities after hepatic resection for hepatocellular carcinoma (HCC). The current study was conducted to evaluate the incidence and different predictive factors for BL after hepatic resection for HCC, and to evaluate of the impact of BL on the long-term survival outcomes.
We reviewed the patients' data who underwent hepatic resection for HCC during the period between June 2010 and June 2019.
A total of 293 patients were included in the study. BL occurred in 17 patients (5.8%). More Child-Pugh class B patients were found in BL group. There were no significant differences between the two groups except for tumor site, macroscopic portal vein invasion, extent of liver resection, Pringle maneuver use, intraoperative blood loss, and transfusions. Longer hospital stay, higher grades of post-hepatectomy liver failure, and abdominal collections were noted in BL group. After median follow-up duration of 17 months (4-110 months), there were no significant differences between BL and non-BL group regarding overall survival (log-rank, p = 0.746) and disease-free survival (log-rank, p = 0.348). In multivariate analysis, Child-Pugh class, macroscopic portal vein invasion, liver resection extent (minor/major), and Pringle's maneuver use were the only significant predictors of BL.
BL did not significantly impair the long-term outcomes after hepatic resection for HCC. Child-Pugh class, macroscopic portal vein invasion, liver resection extent (minor/major), and Pringle's maneuver use were the main risk factors of BL in the current study.
胆漏(BL)是肝细胞癌(HCC)肝切除术后最常见的并发症之一。本研究旨在评估 HCC 肝切除术后 BL 的发生率和不同预测因素,并评估 BL 对长期生存结局的影响。
我们回顾了 2010 年 6 月至 2019 年 6 月期间接受 HCC 肝切除术的患者数据。
共有 293 例患者纳入研究。BL 发生在 17 例患者(5.8%)中。BL 组中更多的患者为 Child-Pugh 分级 B 级。除肿瘤部位、肉眼门静脉侵犯、肝切除范围、Pringle 操作使用、术中出血量和输血外,两组间无显著差异。BL 组的住院时间更长,术后肝功能衰竭分级更高,且有腹部积液。在中位数为 17 个月(4-110 个月)的随访后,BL 组与非 BL 组在总生存(对数秩检验,p=0.746)和无病生存(对数秩检验,p=0.348)方面无显著差异。多因素分析显示,Child-Pugh 分级、肉眼门静脉侵犯、肝切除范围(小/大)和 Pringle 操作使用是 BL 的唯一显著预测因素。
BL 并不显著影响 HCC 肝切除术后的长期结局。Child-Pugh 分级、肉眼门静脉侵犯、肝切除范围(小/大)和 Pringle 操作使用是本研究中 BL 的主要危险因素。