Risk factors and a simple model for predicting bile leakage after radical hepatectomy in patients with hepatic alveolar echinococcosis

Abstract

Postoperative bile leakage (BL) is a major complication of hepatic alveolar echinococcosis (HAE). The purpose of this study was to identify the risk factors for BL and to establish a simple scoring system for predicting BL.A total of 152 patients with HAE were included in the study between May 2004 and December 2016. The patient's baseline data, laboratory blood tests, imaging features, and surgical management were collected. Univariate and multivariate analyses were used to screen for factors to predict BL. The cutoff values for those factors and predictive value of a model were determined by receiver operative characteristic curve (ROC) analysis.BL was detected in 22 of the 152 patients. Univariate analyses showed significant differences in the lesion diameter, levels of lactate dehydrogenase (LDH), alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase and direct bilirubin (DBIL), inferior vena cava invasion, surface area of hepatectomy, blood loss and history of percutaneous transhepatic cholangial drainage between patients with and without BL. On multivariate analyses, DBIL > 7.1 μmol/L, LDH > 194 U/L, lesion diameter > 12 cm and a larger surface area of hepatectomy were independent predictors of BL. The resulting area under the ROC of the scoring model was 0.724 (95% CI, 0.646–0.793).The lesion diameter, DBIL, larger surface area of hepatectomy, and elevated LDH were the important factors affecting the occurrence of BL after surgery. The risk score model will help the clinician to assess BL before surgery. More studies are needed to confirm the scoring model and risk factors.

A new treatment strategy for end-stage hepatic alveolar echinococcosis: IVC resection without reconstruction

“…These metacestodes are predominately located in the liver (60–70%), while a few can be located in the lungs, other abdominal organs, the brain, osseous tissue, and even the thyroid 1 . Approximately 70% of HAE lesions are in the right lobe of the liver, with 40% encroaching on the hepatic hilus and rarely on the IVC 2 . In the liver, the larval lesion grows by exogenous germination, and the liver is impaired by direct erosion, compression, and an inflammatory reaction to EM, which may finally result in liver failure and possibly severe or life-threatening complications, including obstructive jaundice, ascites, and portal hypertension associated with severe cirrhosis 3 .…”

Resection of retrohepatic inferior vena cava without reconstruction in ex vivo liver resection and autotransplantation: a retrospective study

“…Tibetan areas (average elevation of 4,200 meters), medical resources are scarce, education levels are low, and many patients are in advanced stages of treatment, and HAE is more severe than cystic hydatid disease [10,11] . HAE is a seriously neglected parasitic disease that is also known as worm cancer [11,12] . When the hepatic echinococcosis lesion is huge, it often invades the inferior vena cava [13] .…”

Resection of retrohepatic inferior vena cava without reconstruction in ex vivo liver resection and autotransplantation: a retrospective study

“…Tibetan areas (average elevation of 4,200 meters), medical resources are scarce, education levels are low, and many patients are in advanced stages of treatment, and HAE is more severe than cystic hydatid disease [10,11] . HAE is a seriously neglected parasitic disease that is also known as worm cancer [11,12] . When the hepatic echinococcosis lesion is huge, it often invades the inferior vena cava [13] .…”