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Risk factors for bile leakage after liver resection for neoplastic disease

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Abstract

Biliary leakage (BL) remains the most frequent and feared complication after hepatoresective surgery. Placement of the abdominal drainage at the end of liver surgery remains controversial due to the delicate balance between risks and potential benefits in case of BL. The study was aimed to detect possible risk factors for BL occurrence after liver surgery. We enrolled all oncologic patients who underwent liver resection from June 2016 to March 2021. BL was diagnosed according to the ISGLS definition. We have examined demographic characteristics of the patients, type of neoplasia, presence of cirrhosis, neoadjuvant chemotherapy and type of intervention. Uni- and multivariable analyses were performed to assess the predictive value of potential predictor of BL. A total of 379 patients were enrolled in the study, 16 (4.2%) of which developed BL. Among others, at univariate analysis the occurrence of BL was found to be associated with bilio-digestive anastomosis (OR: 9.75, C.I. 2.7–34.7, p < 0.001) and neoadjuvant chemotherapy (OR: 0.09, C.I 0.01,–0.88, p = 0.039). Multivariable analysis selected the body mass index (OR: 1.21, 95%C.I.: 1.04–1.41, p = 0.015), anatomical resection (OR: 8.35, 95% C.I.: 2.01–34.74, p = 0.004), and blood loss (OR: 1.09, 95%C.I.: 1.05–1.13, p < 0.001). Identification of patients at greater risk of BL can help in the choice of positioning the drainage at the end of liver surgery.

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC (University of Pittsburgh Medical Center), 90127, Palermo, Italy

    Sergio Calamia, Sergio Li Petri, Duilio Pagano & Salvatore Gruttadauria

  2. Department of Surgical Oncological and Oral Sciences, University of Palermo, 90127, Palermo, Italy

    Sergio Calamia, Calogero Cipolla, Nello Grassi & Gianni Pantuso

  3. Research Department, IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy

    Marco Barbara

  4. Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95123, Catania, Italy

    Salvatore Gruttadauria

Authors
  1. Sergio Calamia
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  2. Marco Barbara
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  3. Calogero Cipolla
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  4. Nello Grassi
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  5. Gianni Pantuso
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  6. Sergio Li Petri
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  7. Duilio Pagano
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  8. Salvatore Gruttadauria
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Contributions

Conceptualization, SC and SG: validation, SC and DP: formal analysis, MB: resources, SLP: data curation, SC: writing—original draft preparation, SC: writing—review and editing, MB, NG, CC, GP, SLP: supervision, SG. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Salvatore Gruttadauria.

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Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Research Review Board of ISMETT (protocol code IRRB/31/09).

Informed consent statement

Informed consent was obtained from all patients involved in the study.

Risk factors for bile leakage after liver resection for neoplastic disease.

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Calamia, S., Barbara, M., Cipolla, C. et al. Risk factors for bile leakage after liver resection for neoplastic disease. Updates Surg 74, 1581–1587 (2022). https://doi.org/10.1007/s13304-022-01326-1

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