Current management of pyogenic liver abscess: Surgery is now second-line treatment Journal Article
| Authors: | Mezhir, J. J.; Fong, Y.; Jacks, L. M.; Getrajdman, G. I.; Brody, L. A.; Covey, A. M.; Thornton, R. H.; Jarnagin, W. R.; Solomon, S. B.; Brown, K. T. |
| Article Title: | Current management of pyogenic liver abscess: Surgery is now second-line treatment |
| Abstract: | Background: The objective of this study was to examine the current treatment for liver abscess and to assess the factors associated with failure of percutaneous drainage. Study Design: Records of 58 patients with pyogenic hepatic abscess, from 1998 to 2009, were examined. Clinicopathologic variables were analyzed as predictors of failure of percutaneous drainage using multivariable logistic regression. The results of surgical intervention after failure of percutaneous treatment were also examined. Results: Fifty-one patients (88%) had a history of malignancy including pancreas (36%), cholangiocarcinoma (17%), colon (12%), and gallbladder (10%). Recent hepatic artery embolization or radiofrequency ablation preceded development of abscess in 13 patients (22%). Fifteen patients (26%) had evidence of biliary tract communication, and 14 of 15 (93%) of these patients had concomitant biliary tract obstruction. Percutaneous drainage was successful in 38 patients (66%) with a median drain dwell time of 26 days (range 3 to 319 days). Five patients (9%) required operative intervention and 2 of these patients (3% overall) died postoperatively from septic complications. Fifteen patients (26%) died with percutaneous drains in place; 9 (60%) of these patients died of cancer progression without evidence of sepsis. Independent predictors of failure of percutaneous drainage included abscesses containing yeast (p = 0.003) and communication of the abscess cavity with the biliary tree (p = 0.02). Conclusions: Pyogenic hepatic abscess was treated successfully in the majority of patients with advanced malignancy, although mortality remained high. The presence of yeast and communication with an untreated obstructed biliary tree were associated with failure of percutaneous drainage. The need for surgical salvage was associated with a high mortality. © 2010 American College of Surgeons. |
| Keywords: | adult; controlled study; treatment outcome; aged; middle aged; treatment failure; major clinical study; artificial embolism; cancer growth; pancreas cancer; outcome assessment; linear models; disease association; computer assisted tomography; logistic models; risk factors; prediction; risk assessment; postoperative complication; postoperative complications; bilirubin; anti-bacterial agents; colon cancer; reoperation; surgical risk; radiography, interventional; surgical mortality; bile duct carcinoma; bile duct obstruction; blood cell count; microbiology; radiofrequency ablation; metronidazole; quinoline derived antiinfective agent; gallbladder cancer; bilirubin blood level; percutaneous drainage; drainage; piperacillin plus tazobactam; biliary tract disease; timentin; liver artery embolization; postoperative sepsis; pyogenic liver abscess; liver abscess, pyogenic |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 210 |
| Issue: | 6 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-06-01 |
| Start Page: | 975 |
| End Page: | 983 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2010.03.004 |
| PUBMED: | 20510807 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JACSE" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work