Yo-Ichi Yamashita1, Hiroyuki Yamamoto2, Hiroaki Miyata2, Yoshihiro Kakeji3, Yuko Kitagawa3, Hiroki Yamaue4, Masakazu Yamamoto4, Hideo Baba1. 1. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan. 2. Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 3. The Japanese Society of Gastroenterological Surgery, Tokyo, Japan. 4. Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan.
Abstract
BACKGROUND/ PURPOSE: The aim of this study was to identify risk factors for bile leakage in hepatic resections without biliary reconstructions using the large Japanese national clinical database (NCD). METHODS: A total of 10 102 patients who had undergone hepatic resection involving more than one segment without biliary reconstructions for hepatocellular carcinoma during 2015-2017 were enrolled. Risk factors for bile leakage, with special reference to the type of hepatic resection, were identified by multivariable logistic regression analysis. RESULTS: Bile leakage occurred in 726 patients (7.2%). Risk factors for bile leakage were as follows: male sex (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.04-1.58), diabetes mellitus (+) (OR 1.19, 95% CI 1.01-1.39), hemoglobin <10 g/dL (OR 1.4, 95% CI 1.02-1.93), albumin <3.5 g/dL (OR 1.3, 95% CI 1.03-1.63), central bisectionectomy (OR 3.8, 95% CI 2.81-5.13), left trisectionectomy (OR 3.6, 95% CI 2.10-6.15), right anterior sectionectomy (OR 2.07, 95% CI 1.58-2.72), and S5 or S8 segmentectomy (OR 1.33, 95% CI 1.00-1.77). CONCLUSION: Central bisectionectomy, left trisectionectomy, and right anterior sectionectomy are high-risk types of hepatic resection for bile leakage.
BACKGROUND/ PURPOSE: The aim of this study was to identify risk factors for bile leakage in hepatic resections without biliary reconstructions using the large Japanese national clinical database (NCD). METHODS: A total of 10 102 patients who had undergone hepatic resection involving more than one segment without biliary reconstructions for hepatocellular carcinoma during 2015-2017 were enrolled. Risk factors for bile leakage, with special reference to the type of hepatic resection, were identified by multivariable logistic regression analysis. RESULTS: Bile leakage occurred in 726 patients (7.2%). Risk factors for bile leakage were as follows: male sex (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.04-1.58), diabetes mellitus (+) (OR 1.19, 95% CI 1.01-1.39), hemoglobin <10 g/dL (OR 1.4, 95% CI 1.02-1.93), albumin <3.5 g/dL (OR 1.3, 95% CI 1.03-1.63), central bisectionectomy (OR 3.8, 95% CI 2.81-5.13), left trisectionectomy (OR 3.6, 95% CI 2.10-6.15), right anterior sectionectomy (OR 2.07, 95% CI 1.58-2.72), and S5 or S8 segmentectomy (OR 1.33, 95% CI 1.00-1.77). CONCLUSION: Central bisectionectomy, left trisectionectomy, and right anterior sectionectomy are high-risk types of hepatic resection for bile leakage.