Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer

ARTICLE HIGHLIGHTS

Research background

Bile leakage is a common and significant complication of open hepatectomy, a surgical procedure performed to treat biliary tract cancer. Bile leaks are characterized by the drainage of bile from the surgical site or drain or the formation of a biloma (a localized collection of bile), as observed on imaging scans. This complication can lead to various adverse outcomes including infection, abscess formation, sepsis, delayed wound healing, and prolonged hospital stay. Therefore, understanding the incidence, risk factors, and management strategies of bile leaks is crucial to improve patient outcomes and reduce the burden on the healthcare system.

Research motivation

Bile leakage is a significant complication of open hepatectomy for the treatment of biliary tract cancer. However, few studies have focused on the incidence, risk factors, and management of these complications. Therefore, this study aimed to address this knowledge gap by conducting a comprehensive analysis of 120 patients who underwent open hepatectomy for biliary tract cancer. The motivation for this study lies in the need to better understand the frequency, associated risk factors, and effective management strategies of bile leaks. By identifying these factors, healthcare professionals can improve patient outcomes, reduce complications, and optimize treatment approaches in patients undergoing open hepatectomy for biliary tract cancer.

Research objectives

Evaluate the incidence of bile leak after open hepatectomy for biliary tract cancer. Identify the risk factors associated with bile leakage in this patient population. Investigate the management strategies employed for bile leaks, including conservative approaches and interventional procedures. Assess the severity, timing, location, and duration of bile leaks following open hepatectomy. Determine the association between specific risk factors, such as male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion, and the occurrence of bile leaks. By achieving these objectives, the study aimed to provide valuable insights into the incidence, risk factors, and management of bile leak complications after open hepatectomy for biliary tract cancer, ultimately contributing to improved patient care and surgical outcomes.

Research methods

Study population: Patient data from open hepatectomy for biliary tract cancer (February 2018 to February 2023) were retrospectively analyzed. Data Collection: Information on bile leak complications (incidence, severity, timing, location, and treatment) was obtained from patient records and charts. Bile Leak Definition: Defined as bile drainage or presence of biloma observed on imaging. Statistical Analysis: Univariate and multivariate logistic regression analyses were used to assess the risk factors (sex, hepatocellular carcinoma, major hepatectomy, blood loss, and transfusion). Utilizing existing data allows for cost-effective investigations, while statistical analyses enhance understanding. These findings provide insights into bile leak management and may improve the care of patients undergoing open hepatectomy.

Research results

Bile leak occurred in 16.7% (20/120) of patients who underwent open hepatectomy for biliary tract cancer. Most cases were grade A, with a median onset time of 5 d and duration of 7 d. The cut surface of the liver was the most common site of leakage (70%). Conservative treatment was successful in 85% of cases, while 10% required endoscopic retrograde cholangiopancreatography (ERCP) with stenting and 5% required percutaneous transhepatic cholangiography (PTC) with drainage. Male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion were identified as risk factors for bile leak.

Research conclusions

This study provides new insights into the incidence, risk factors, and management of bile leak after open hepatectomy for biliary tract cancer. It highlights that bile leakage is a common complication, with an incidence rate of 16.7%. This study identified male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion as significant risk factors for bile leakage. This suggests that conservative management, including drainage, antibiotics, and nutritional support, is effective in most cases. The study also mentioned the use of ERCP with stenting or PTC with drainage as alternative treatment options.

Research perspectives

Future studies should focus on developing strategies to reduce the incidence of bile leakage after open hepatectomy for biliary tract cancer. Investigating the use of advanced imaging techniques for early detection and assessment of bile leaks could improve patient outcomes. Additionally, the potential of minimally invasive surgical techniques and perioperative interventions to reduce the risk of bile leakage warrants further investigation. Long-term follow-up studies are needed to evaluate the effects of bile leak on patient survival and quality of life. Collaborative efforts are necessary to establish standardized guidelines and protocols for the prevention, diagnosis, and management of bile leakage in clinical practice.