Document Detail


Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer.
MedLine Citation:
PMID:  22794706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this study was to identify predictors of treatment failure of percutaneous catheter drainage (PCD) in patients with hepatobiliary-pancreatic cancer with pyogenic liver abscess (PLA).
METHODS: Medical records of 44 patients with PLA with underlying hepatobiliary-pancreatic cancer who underwent PCD under computed tomographic guidance as primary treatment between January 2001 and December 2010 were collected and reviewed. Included patients were diagnosed with cholangiocarcinoma (n = 16), hepatocellular carcinoma (n = 12), pancreatic carcinoma (n = 9), carcinoma of the ampulla of Vater (n = 6), and gallbladder cancer (n = 1). The clinical factors related to failure of PCD were determined using logistic regression.
RESULTS: The median age of the 44 patients with PLA was 68 years, and 48% were men. PCD failed in 15 patients (34%). Of the 15 patients with PCD failure, 12 subsequently required surgical intervention because of either clinical deterioration or imaging that demonstrated failure of abscess resolution with PCD. Three of these patients died with the initial drain in place before resolution of the abscess. In patients requiring surgery after PCD failure, the frequency of cure or abscess resolution reached 67%. Fourteen patients (32%) died during hospitalization. Multivariate analysis identified that multiloculated abscesses (P = .005) and abscesses with biliary communication (P = .036) were associated with failure of PCD.
CONCLUSIONS: Multiloculated abscesses and lesions with biliary communication pose a greater likelihood of failure of PCD in patients with hepatobiliary-pancreatic cancer with PLA. Early surgical intervention after PCD failure should be considered for these patients.
Authors:
Kuang-Chi Lai; Ken-Sheng Cheng; Long-Bin Jeng; Chi-Chou Huang; Yuan-Ti Lee; Horng-Rong Chang; Chun-Chieh Chen; Shiuan-Chih Chen; Meng-Chih Lee
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Publication Detail:
Type:  Journal Article     Date:  2012-07-12
Journal Detail:
Title:  American journal of surgery     Volume:  205     ISSN:  1879-1883     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-18     Completed Date:  2013-03-12     Revised Date:  2013-04-29    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Surgery, China Medical University Beigang Hospital, Yunlin 65152, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / therapeutic use
Biliary Tract Neoplasms / complications*
Carcinoma / complications
Catheterization, Peripheral / methods*
Cholestasis / complications,  therapy
Drainage / methods*
Female
Humans
Liver Abscess, Pyogenic / complications,  microbiology,  therapy*
Liver Neoplasms / complications*
Male
Middle Aged
Multivariate Analysis
Pancreatic Neoplasms / complications*
Radiography, Interventional
Retrospective Studies
Tomography, X-Ray Computed
Treatment Failure
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents
Comments/Corrections
Comment In:
Am J Surg. 2013 Apr;205(4):479-80   [PMID:  23375754 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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