TY - JOUR
T1 - Risk factors for major morbidity after hepatectomy for hepatocellular carcinoma in 293 recent cases
AU - Sadamori, Hiroshi
AU - Yagi, Takahito
AU - Matsuda, Hiroaki
AU - Shinoura, Susumu
AU - Umeda, Yuzo
AU - Yoshida, Ryuichi
AU - Satoh, Daisuke
AU - Utsumi, Takasi
AU - Ohnishi, Teppei
PY - 2010/9
Y1 - 2010/9
N2 - Background/Purpose: The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC). Methods: Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008. Results: Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time ≥ 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies. Conclusions: Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
AB - Background/Purpose: The purpose of this study was to identify risk factors for major morbidity after hepatectomies for hepatocellular carcinoma (HCC). Methods: Univariate and multivariate analyses of risk factors for major morbidity were performed in 293 patients who underwent hepatectomy for HCC between 2001 and 2008. Results: Two hundred and forty-three patients (82.9%) underwent an anatomic hepatectomy, and a repeat hepatectomy was performed in 50 patients (17.1%). The prevalences of bile leakage and intraabdominal abscess were 12.9% and 9.2%, respectively. The risk factor for bile leakage was an operative time ≥ 300 min and the risk factor for intraabdominal abscess was a repeat hepatectomy (odds ratios = 4.9 and 5.3, respectively). The main cause of bile leakage that made endoscopic therapy or percutaneous transhepatic biliary drainage necessary was a latent stricture of the biliary anatomy that had existed preoperatively, caused by previous treatments for HCC. Methicillin-resistant Staphylococcus aureus was the main causative bacteria of intraabdominal abscess after repeat hepatectomies. Conclusions: Our recent series revealed that prolonged operative time and repeat hepatectomy were independent risk factors for bile leakage and intraabdominal abscess, respectively, after hepatectomies for HCC. Preoperative assessment of the biliary anatomy should be considered for patients who have had previous multiple treatments for HCC, including hepatectomy, to reduce bile leakage that makes invasive treatment necessary.
KW - Bile leakage
KW - Hepatectomy
KW - Hepatocellular carcinoma
KW - Intraabdominal abscess
KW - Morbidity
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U2 - 10.1007/s00534-010-0275-3
DO - 10.1007/s00534-010-0275-3
M3 - Article
C2 - 20703850
AN - SCOPUS:79952110546
VL - 17
SP - 709
EP - 718
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
SN - 1868-6974
IS - 5
ER -