Factors associated with treatment failure of percutaneous catheter drainage for pyogenic liver abscess in patients with hepatobiliary-pancreatic cancer

• Published in: The American journal of surgery Vol. 205; no. 1; pp. 52 - 57
• Main Authors: Lai, Kuang-Chi, M.D., Ph.D, Cheng, Ken-Sheng, M.D, Jeng, Long-Bin, M.D, Huang, Chi-Chou, M.D., Ph.D, Lee, Yuan-Ti, M.D., Ph.D, Chang, Horng-Rong, M.D., Ph.D, Chen, Chun-Chieh, M.D., Ph.D, Chen, Shiuan-Chih, M.D., Ph.D, Lee, Meng-Chih, M.D., Ph.D., M.P.H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013; Elsevier Limited
• Subjects: Aged; Anti-Bacterial Agents - therapeutic use; Biliary tract neoplasms; Biliary Tract Neoplasms - complications; Carcinoma - complications; Catheterization, Peripheral - methods; Cholestasis - complications; Cholestasis - therapy; Drainage - methods; Female; Humans; Infections; Liver Abscess, Pyogenic - complications; Liver Abscess, Pyogenic - microbiology; Liver Abscess, Pyogenic - therapy; Liver neoplasms; Liver Neoplasms - complications; Male; Middle Aged; Multivariate Analysis; Pancreas; Pancreatic cancer; Pancreatic neoplasms; Pancreatic Neoplasms - complications; Percutaneous drainage; Pyogenic liver abscess; Radiography, Interventional; Retrospective Studies; Studies; Surgery; Therapeutics; Tomography, X-Ray Computed; Treatment Failure; Biliary tract neoplasms; Percutaneous drainage; Pyogenic liver abscess; Liver neoplasms; Pancreatic neoplasms; Therapeutics
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2012.03.006

Abstract 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.