Top

Published in:

01-04-2018 | Original Article

Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection

Authors: Allison N. Martin, Sowmya Narayanan, Florence E. Turrentine, Todd W. Bauer, Reid B. Adams, George J. Stukenborg, Victor M. Zaydfudim

Published in: Journal of Gastrointestinal Surgery | Issue 4/2018

Abstract

Background

Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality.

Methods

Adult patients in the 2014–2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak.

Results

Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p < 0.001). The proportion of patients with bile leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p < 0.001). Postoperative mortality was significantly greater in patients with bile leaks (6.0 vs. 1.7%, p < 0.001). After adjusting for significant covariates, bile leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72–5.56; p < 0.001). After adjusting for significant effects of postoperative complications, liver failure, and reoperation (all p<0.001), bile leak was not independently associated with increased risk of postoperative mortality (p = 0.262).

Conclusion

Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.

Dimick JB, Wainess RM, Cowan JA, Upchurch GR, Jr., Knol JA, Colletti LM. National trends in the use and outcomes of hepatic resection. J Am Coll Surg. 2004;199(1):31–8. doi: https://doi.org/10.1016/j.jamcollsurg.2004.03.005. PubMed

Foster JH, Berman MM. Solid liver tumors. Major Probl Clin Surg. 1977;22:1–342. PubMed

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397–406; discussion −7. doi: https://doi.org/10.1097/01.SLA.0000029003.66466.B3. PubMed PMID: 12368667; PubMed Central PMCID: PMCPMC1422593.

Yokoo H, Miyata H, Konno H, Taketomi A, Kakisaka T, Hirahara N, et al. Models predicting the risks of six life-threatening morbidities and bile leakage in 14,970 hepatectomy patients registered in the National Clinical Database of Japan. Medicine (Baltimore). 2016;95(49):e5466. doi: https://doi.org/10.1097/MD.0000000000005466. PubMed PMID: 27930526; PubMed Central PMCID: PMCPMC5265998.

Zimmitti G, Vauthey JN, Shindoh J, Tzeng CW, Roses RE, Ribero D, et al. Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Coll Surg. 2013;217(6):1028–37. doi: https://doi.org/10.1016/j.jamcollsurg.2013.07.392. PubMed PMID: 24246619; PubMed Central PMCID: PMCPMC3880182.

Brauer DG, Nywening TM, Jaques DP, Doyle MB, Chapman WC, Fields RC, et al. Operative Site Drainage after Hepatectomy: A Propensity Score Matched Analysis Using the American College of Surgeons NSQIP Targeted Hepatectomy Database. J Am Coll Surg. 2016;223(6):774–83 e2. doi: https://doi.org/10.1016/j.jamcollsurg.2016.09.004. PubMed PMID: 27793459; PubMed Central PMCID: PMCPMC5125822.

Spolverato G, Ejaz A, Kim Y, Hall BL, Bilimoria K, Cohen M, et al. Patterns of care among patients undergoing hepatic resection: a query of the National Surgical Quality Improvement Program-targeted hepatectomy database. J Surg Res. 2015;196(2):221–8. doi: https://doi.org/10.1016/j.jss.2015.02.016. PubMed

Alexiou VG, Tsitsias T, Mavros MN, Robertson GS, Pawlik TM. Technology-assisted versus clamp-crush liver resection: a systematic review and meta-analysis. Surg Innov. 2013;20(4):414–28. doi: https://doi.org/10.1177/1553350612468510. PubMed

Kaibori M, Ishizaki M, Matsui K, Kwon AH. Intraoperative indocyanine green fluorescent imaging for prevention of bile leakage after hepatic resection. Surgery. 2011;150(1):91–8. doi: https://doi.org/10.1016/j.surg.2011.02.011. PubMed

10.

Lam CM, Lo CM, Liu CL, Fan ST. Biliary complications during liver resection. World J Surg. 2001;25(10):1273–6. PubMed

11.

Zimmitti G, Roses RE, Andreou A, Shindoh J, Curley SA, Aloia TA, et al. Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: an experience with 2,628 consecutive resections. J Gastrointest Surg. 2013;17(1):57–64; discussion p −5. doi: https://doi.org/10.1007/s11605-012-2000-9. PubMed PMID: 22956403; PubMed Central PMCID: PMCPMC3855461.

12.

Okumura K, Sugimachi K, Kinjo N, Shoji F, Ikebe M, Makino I, et al. Risk factors of bile leakage after hepatectomy for hepatocellular carcinoma. Hepatogastroenterology. 2013;60(127):1717–9. PubMed

13.

Sadamori H, Yagi T, Shinoura S, Umeda Y, Yoshida R, Satoh D, et al. Risk factors for major morbidity after liver resection for hepatocellular carcinoma. Br J Surg. 2013;100(1):122–9. doi: https://doi.org/10.1002/bjs.8957. PubMed

14.

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(5):680–8. doi: https://doi.org/10.1016/j.surg.2010.12.002. PubMed

15.

Wiggers JK, Groot Koerkamp B, Cieslak KP, Doussot A, van Klaveren D, Allen PJ, et al. Postoperative Mortality after Liver Resection for Perihilar Cholangiocarcinoma: Development of a Risk Score and Importance of Biliary Drainage of the Future Liver Remnant. J Am Coll Surg. 2016;223(2):321–31 e1. doi: https://doi.org/10.1016/j.jamcollsurg.2016.03.035. PubMed PMID: 27063572; PubMed Central PMCID: PMCPMC4961586.

16.

Zaydfudim VM, Rosen CB, Nagorney DM. Hilar cholangiocarcinoma. Surg Oncol Clin N Am. 2014;23(2):247–63. doi: https://doi.org/10.1016/j.soc.2013.10.005. PubMed

17.

Shubert CR, Habermann EB, Truty MJ, Thomsen KM, Kendrick ML, Nagorney DM. Defining perioperative risk after hepatectomy based on diagnosis and extent of resection. J Gastrointest Surg. 2014;18(11):1917–28. doi: https://doi.org/10.1007/s11605-014-2634-x. PubMed

18.

Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009;250(5):831–41. doi: https://doi.org/10.1097/SLA.0b013e3181b0c4df. PubMed

19.

Mehta VV, Fisher SB, Maithel SK, Sarmiento JM, Staley CA, Kooby DA. Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies. J Am Coll Surg. 2013;216(4):635–42; discussion 42-4. doi: https://doi.org/10.1016/j.jamcollsurg.2012.12.040. PubMed

20.

van der Wilt AA, Coolsen MM, de Hingh IH, van der Wilt GJ, Groenewoud H, Dejong CH, et al. To drain or not to drain: a cumulative meta-analysis of the use of routine abdominal drains after pancreatic resection. HPB (Oxford). 2013;15(5):337–44. doi: https://doi.org/10.1111/j.1477-2574.2012.00609.x. PubMed PMID: 23557407; PubMed Central PMCID: PMCPMC3633034.

21.

Van Buren G, 2nd, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2014;259(4):605–12. doi: https://doi.org/10.1097/SLA.0000000000000460. PubMed

22.

Ferrero A, Russolillo N, Vigano L, Sgotto E, Lo Tesoriere R, Amisano M, et al. Safety of conservative management of bile leakage after hepatectomy with biliary reconstruction. J Gastrointest Surg. 2008;12(12):2204–11. doi: https://doi.org/10.1007/s11605-008-0586-8. PubMed

23.

Vigano 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(2):195–200. doi: https://doi.org/10.1016/j.amjsurg.2007.08.062. PubMed

24.

Lo CM, Fan ST, Liu CL, Lai EC, Wong J. Biliary complications after hepatic resection: risk factors, management, and outcome. Arch Surg. 1998;133(2):156–61. PubMed

25.

Li SQ, Liang LJ, Peng BG, Lu MD, Lai JM, Li DM. Bile leakage after hepatectomy for hepatolithiasis: risk factors and management. Surgery. 2007;141(3):340–5. doi: https://doi.org/10.1016/j.surg.2006.08.013. PubMed

26.

Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: Where is the risk? Arch Surg. 2006;141(7):690–4; discussion 5. doi: https://doi.org/10.1001/archsurg.141.7.690. PubMed

27.

Kubo S, Sakai K, Kinoshita H, Hirohashi K. Intraoperative cholangiography using a balloon catheter in liver surgery. World J Surg. 1986;10(5):844–50. PubMed

28.

Yamashita Y, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, et al. Bile leakage after hepatic resection. Ann Surg. 2001;233(1):45–50. PubMed PMID: 11141224; PubMed Central PMCID: PMCPMC1421165.

Title: Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection
Authors: Allison N. Martin
Sowmya Narayanan
Florence E. Turrentine
Todd W. Bauer
Reid B. Adams
George J. Stukenborg
Victor M. Zaydfudim
Publication date: 01-04-2018
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 4/2018
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3650-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Anthropometric Changes in Patients with Pancreatic Cancer Undergoing Preoperative Therapy and Pancreatoduodenectomy

Association of Adjuvant Therapy with Improved Survival in Ampullary Cancer: A National Cohort Study

Diffuse Calcified Gastric Cancer

The Effect of Frailty Index on Early Outcomes after Combined Colorectal and Liver Resections

The Stomach: a Rare Site for Metastatic Solid Pseudopapillary Neoplasm of the Pancreas

Comparison of Hepatectomy for Patients with Metabolic Syndrome-Related HCC and HBV-Related HCC