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

Table 1 Patient characteristics and operative details

Patient demographics and characteristics	Value
Age (yr)	62.3 ± 10.4
Sex (male/female)	68/52
Body mass index (kg/m2)	24.5 ± 3.2
ASA score (I/II/III)	12/84/24
Child-Pugh class (A/B)	108/12
MELD score	8.7 ± 2.4
Albumin (g/L)	38.6 ± 4.5
Total bilirubin (µmol/L)	17.5 ± 6.8
INR	1.05 ± 0.08
Platelet count (× 109/L)	198.5 ± 76.4
Tumor type, n (%)
Intrahepatic cholangiocarcinoma	54 (45)
Gallbladder cancer	36 (30)
Extrahepatic cholangiocarcinoma	30 (25)
Tumor size (cm)	6.3 ± 1.5

ASA: American Society of Anesthesiologists; MELD: Model for End-Stage Liver Disease; INR: International normalized ratio.

Table 2 Postoperative complications and outcomes, n (%)

Complication type	Value
Morbidity	46 (38.3)
Bile leak	20 (16.7)
Wound infection	12 (10)
Ascites	10 (8.3)
Liver failure	4 (3.3)
Bleeding	3 (2.5)
Sepsis	2 (1.7)
Cholangitis	2 (1.7)
Pulmonary embolism	1 (0.8)
Mortality	2 (1.7)
Length of hospital stay (d)	12 (7-35)

Table 3 Characteristics of bile leak

Bile leak details	Value
Time of onset (d)	5 (1-14)
Duration (d)	7 (2-28)
ISGLS grade, n (%)
A	15 (75)
B	4 (20)
C	1 (5)
Location, n (%)
Cut surface of liver	14 (70)
Anastomosis site	5 (25)
Cystic duct stump	1 (5)

ISGLS: International Study Group of Liver Surgery.

Table 4 Management and outcomes of bile leak, n (%)

Management and outcome	Value
Management
Conservative	17 (85)
Endoscopic	2 (10)
Percutaneous	2 (10)
Surgical	1 (5)
Outcome
Resolution	18 (90)
Persistence	2 (10)

Table 5 Risk factors for bile leak

Variables	Univariate analysis results	Multivariate analysis results
Age (> 60 yr)	OR 1.4, 95%CI: 0.6-3.2, P = 0.42
Sex (male)	OR 3.1, 95%CI: 1.2-7.9, P = 0.02	OR 2.6, 95%CI: 1.1-6.8, P = 0.03
BMI (> 25 kg/m2)	OR 1.3, 95%CI: 0.6-3.0, P = 0.51
ASA score (> II)	OR 1.8, 95%CI: 0.8-4.3, P = 0.16
Child-Pugh class (B)	OR 1.5, 95%CI: 0.5-4.7, P = 0.47
MELD score (> 10)	OR 1.7, 95%CI: 0.7-4.1, P = 0.24
Albumin (< 35 g/L)	OR 1.9, 95%CI: 0.8-4.5, P = 0.14
Total bilirubin (> 20 µmol/L)	OR 1.6, 95%CI: 0.7-3.8, P = 0.27
INR (> 1.1)	OR 1.4, 95%CI: 0.6-3.3, P = 0.44
Platelet count (< 150 × 109/L)	OR 1.2, 95%CI: 0.5-2.8, P = 0.66
Tumor type (HCC)	OR 4.3, 95%CI: 1.8-10.5, P < 0.01	OR 3.1, 95%CI: 1.4-7.2, P < 0.01
Tumor size (> 5 cm)	OR 1.9, 95%CI: 0.9-3.9, P = 0.09
Type of hepatectomy (major)	OR 5.6, 95%CI: 2.3-13.7, P < 0.01	OR 4.2, 95%CI: 1.9-9.4, P < 0.01
Blood loss (> 1000 mL)	OR 3, 95%CI: 1.2-7.4, P = 0.02	OR 2.7, 95%CI: 1.2-6.3, P = 0.02
Blood transfusion (yes)	OR 4, 95%CI: 1.6-10, P < 0.01	OR 3.4, 95%CI: 1.5-7.8, P < 0.01

ASA: American Society of Anesthesiologists; MELD: Model for End-Stage Liver Disease; INR: International normalized ratio; HCC: Hepatocellular carcinoma.