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Yang XM, Yang XY, Wang XY, Gu YX. Influence of transcatheter arterial embolization on symptom distress and fatigue in liver cancer patients. World J Gastrointest Oncol 2024; 16:810-818. [PMID: 38577467 PMCID: PMC10989373 DOI: 10.4251/wjgo.v16.i3.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a prevalent malignancy, and transcatheter arterial embolization (TAE) has emerged as a pivotal therapeutic modality. However, TAE may induce symptom distress and fatigue, adversely affecting the quality of life of patients. AIM To investigate symptom distress, fatigue, and associated factors in HCC patients undergoing TAE. METHODS We used a cross-sectional design and purposive sampling to enroll HCC patients who underwent TAE at our institution from January to December 2022. Questionnaires were utilized to collect data on symptom distress and fatigue scores from the first to the third day after TAE. RESULTS Our study revealed a significant reduction in fatigue and symptom distress among patients after TAE. Pain, fatigue, insomnia, fever and abdominal distension were the most common symptoms troubling patients during the first 3 d post-TAE. Marital status, presence of family support, physical functional status, age, and symptom distress were identified as predictors of fatigue in patients. CONCLUSION Healthcare professionals should educate HCC patients on symptom distress and fatigue, offering personalized relief strategies to lessen their psychological burden.
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Affiliation(s)
- Xu-Min Yang
- Department of Nursing, The First Affiliated Hospital of Naval Medical University (Changhai Hospital), Shanghai 200433, China
| | - Xu-Yan Yang
- Department of Nursing, The First Affiliated Hospital of Naval Medical University (Changhai Hospital), Shanghai 200433, China
| | - Xin-Yu Wang
- Department of Thyroid, Breast and Vascular Surgery, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
| | - Yue-Xia Gu
- Department of Nursing, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai 200434, China
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2
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Wu G, Li WY, Gong YX, Lin F, Sun C. Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer. World J Gastrointest Surg 2024; 16:67-75. [PMID: 38328317 PMCID: PMC10845266 DOI: 10.4240/wjgs.v16.i1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/09/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer. AIM To evaluate the incidence, risk factors, and management of bile leakage after open hepatectomy in patients with biliary tract cancer. METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023. Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging. The incidence, severity, timing, location, and treatment of the bile leaks were recorded. The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses. RESULTS The incidence of bile leak was 16.7% (20/120), and most cases were grade A (75%, 15/20) according to the International Study Group of Liver Surgery classification. The median time of onset was 5 d (range, 1-14 d), and the median duration was 7 d (range, 2-28 d). The most common location of bile leakage was the cut surface of the liver (70%, 14/20), followed by the anastomosis site (25%, 5/20) and the cystic duct stump (5%, 1/20). Most bile leaks were treated conservatively with drainage, antibiotics, and nutritional support (85%, 17/20), whereas some required endoscopic retrograde cholangiopancreatography with stenting (10%, 2/20) or percutaneous transhepatic cholangiography with drainage (5%, 1/20). Risk factors for bile leakage include male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion. CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer. However, most cases are mild and can be conservatively managed. Male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion were associated with an increased risk of bile leak.
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Affiliation(s)
- Gang Wu
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Wen-Ying Li
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Yu-Xing Gong
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Feng Lin
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Chen Sun
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
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Dell T, Meyer C. [Biliary system interventions : Percutaneous transhepatic cholangiodrainage to bilioma]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:30-37. [PMID: 36413258 DOI: 10.1007/s00117-022-01083-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND A variety of transhepatic percutaneous biliary procedures are appropriate for the treatment of pathologies of the biliary system. OBJECTIVES The aim of this article is to describe best practices for performing percutaneous transhepatic cholangiography with placement of a biliary drain (PTCD), percutaneous transhepatic removal of bile duct stones, percutaneous stenting of the bile ducts, and percutaneous treatment of postoperative bilioma. MATERIALS AND METHODS The authors reviewed existing literature on relevant current recommendations and presented them based on their own facility's approach. RESULTS Biliary interventions are mostly aimed at treating some form of cholestasis of benign or malignant etiology. The technical success rate is up to 90%. CONCLUSION Percutaneous biliary interventions are safe and effective procedures in the treatment of pathologies of the biliary system, preferably used when endoscopic access is not possible due to anatomical conditions.
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Affiliation(s)
- Tatjana Dell
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Carsten Meyer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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Houghton EJ, Rubio JS. Surgical management of the postoperative complications of hepato-pancreato-biliary surgery. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eduardo Javier Houghton
- Teaching and Research Department, DAICIM Foundation, Buenos Aires, Argentina
- Surgery Division, B. Rivadavia Hospital, Buenos Aires, Argentina
- Department of Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Juan Santiago Rubio
- Solid Organ Transplant Service, Hospital de Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina
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Tan L, Liu F, Liu ZL, Xiao JW. Meta-Analysis of Risk Factors for Bile Leakage After Hepatectomy Without Biliary Reconstruction. Front Surg 2021; 8:764211. [PMID: 34790696 PMCID: PMC8591075 DOI: 10.3389/fsurg.2021.764211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Aim: The risk factors for bile leakage after hepatectomy without biliary reconstruction are controversial. This study investigated the risk factors for bile leakage after hepatectomy without biliary reconstruction. Methods: We searched databases (Embase (Ovid), Medline (Ovid), PubMed, Cochrane Library, and Web of Science) for articles published between January 1, 2000, and May 1, 2021, to evaluate the risk factors for bile leakage after hepatectomy without biliary reconstruction. Results: A total of 16 articles were included in this study, and the overall results showed that sex (OR: 1.21, 95% CI: 1.04–1.42), diabetes (OR: 1.21, 95% CI: 1.05–1.38), left trisectionectomy (OR: 3.53, 95% CI: 2.32–5.36), central hepatectomy (OR: 3.28, 95% CI: 2.63–4.08), extended hemihepatectomy (OR: 2.56, 95% CI: 1.55–4.22), segment I hepatectomy (OR: 2.56, 95% CI: 1.50–4.40), intraoperative blood transfusion (OR:2.40 95%CI:1.79–3.22), anatomical hepatectomy (OR: 1.70, 95% CI: 1.19–2.44) and intraoperative bleeding ≥1,000 ml (OR: 2.46, 95% CI: 2.12–2.85) were risk factors for biliary leakage. Age >75 years, cirrhosis, underlying liver disease, left hepatectomy, right hepatectomy, benign disease, Child–Pugh class A/B, and pre-operative albumin <3.5 g/dL were not risk factors for bile leakage after hepatectomy without biliary reconstruction. Conclusion: Comprehensive research in the literature revealed that sex, diabetes, left trisectionectomy, central hepatectomy, extended hemihepatectomy, segment I hepatectomy, intraoperative blood transfusion, anatomical hepatectomy and intraoperative bleeding ≥1,000 ml were risk factors for biliary leakage.
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Affiliation(s)
- Ling Tan
- Department of Gastrointestinal Surgery, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Zi-Lin Liu
- Department of Gastrointestinal Surgery, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jiang-Wei Xiao
- Department of Gastrointestinal Surgery, Clinical Medical College and the First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Karatoprak S, Kutlu R, Karatoprak NB, Dağ N, Yılmaz S. Percutaneous radiological biliary interventions after failed endoscopic treatment in living liver donors: experience of a high-volume transplantation center. Transpl Int 2021; 34:2846-2855. [PMID: 34559926 DOI: 10.1111/tri.14118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/02/2021] [Accepted: 09/21/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to evaluate the role of percutaneous radiological treatments for biliary complications (BCs) in donors after living donor liver transplantation (LDLT). We retrospectively evaluated BCs in donors involved in 1839 LDLTs between May 2009 and January 2019 at our centre. BCs were classified according to the modified Clavien-Dindo classification (MCDC). Patients treated with percutaneous transhepatic biliary intervention (PTBI) were identified. Complications requiring endoscopic, interventional or surgical treatment (MCDC grades III-IV) involved 123 (6.6%) donors. Complications comprised leakage, n = 73 (60%); stricture, n = 36 (29%); and both leakage and stricture, n = 14 (11%). Percutaneous drainage of biloma formations under ultrasound guidance was performed in 57 donors, endoscopic treatment in 83 and PTBI in 14. Of 83 patients who received endoscopic treatment, 13 were referred for PTBI due to failure or uncannulation. Eight of 14 patients were successfully treated with PTBI. Six patients were treated with a rendezvous procedure combining percutaneous and surgical treatments. In 13 patients, no BCs were developed after catheter or stent removal. In donors with BCs, the treatment should progress from the least invasive method to surgery. In some patients, percutaneous radiological treatments eliminate the need for surgery or can guide surgical treatment.
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Affiliation(s)
- Sinan Karatoprak
- Department of Radiology and Liver Transplantation Institute, School of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Kutlu
- Department of Radiology and Liver Transplantation Institute, School of Medicine, Inonu University, Malatya, Turkey
| | - Nur Betül Karatoprak
- Department of Radiology and Liver Transplantation Institute, School of Medicine, Inonu University, Malatya, Turkey
| | - Nurullah Dağ
- Department of Radiology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Sezai Yılmaz
- Department of General Surgery and Liver Transplantation Institute, School of Medicine, Inonu University, Malatya, Turkey
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Yamashita YI, Yamamoto H, Miyata H, Kakeji Y, Kitagawa Y, Yamaue H, Yamamoto M, Baba H. Risk factors for bile leakage: Latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 28:556-562. [PMID: 32897639 DOI: 10.1002/jhbp.827] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Yamamoto
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Hiroki Yamaue
- Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| | | | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Li P, Zhang D, Zheng C, Guo C. Development and validation of the bile leakage grading criterion in patients following Roux-en-Y hepaticojejunostomy. Asian J Surg 2020; 44:358-362. [PMID: 32981821 DOI: 10.1016/j.asjsur.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/16/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The present research aimed to propose a severity grading criterion for bile leakage in pediatric patients after Roux-en-Y hepaticojejunostomy for choledochal cysts. SUMMARY BACKGROUND DATA Despite a bile leakage classification system from the International Study Group of Liver Surgery (ISGLS) has been developed, a commonly used grading system for pediatric patients after Roux-en-Y hepaticojejunostomy has not yet been established. METHODS A review of clinical, laboratory, and ultrasonographic parameters were used to develop a grading system for classifying the severity of bile leakage. A total of 267 patients with bile leakage were retrospectively assessed to review the system. RESULTS We developed a grading system for bile leakage severity for use in pediatric patients following Roux-en-Y hepaticojejunostomy. By applying the criteria to 267 patients, grade I, II, or III bile leakage was determined in 103 patients (8.7%), 115 patients (9.8%), and 49 patients (4.2%) patients, respectively. The most severe bile leakage grade (grade III), was associated with significantly higher γ-glutamyl transpeptidase and amylase levels, greater drain fluid output, more intensive care unit (ICU) admissions, and longer postoperative hospital stay. Interestingly, patients with grade II leakage who underwent reoperation had significantly more ICU admissions, longer postoperative hospital stays (p < 0.05), and higher overall hospitalization cost (p < 0.05) compared with those who underwent conservation management. Of the patients with bile duct stricture and common bile duct (CBD) stones, there were no differences among the different grades of postoperative bile leakage. CONCLUSIONS The proposed bile leakage criteria may optimize objective diagnosis and therapeutic modalities.
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Affiliation(s)
- Ping Li
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Dianliang Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China; Department of Colorectal Surgery, Qingdao Municipal Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Chao Zheng
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
| | - Chunbao Guo
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China; Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital of Chongqing Medical University, Chongqing, PR China; Ministry of Education Key Laboratory of Child Development and Disorders National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, PR China.
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Cha JG, Lee SY, Ryeom HK, Hong J, Tak WY, Jang SY, Kweon YO, Park SY, Lee YR. Percutaneous portal vein embolization for intractable hepatic biloma after radiofrequency ablation. Eur J Radiol Open 2020; 7:100300. [PMID: 33304943 PMCID: PMC7711210 DOI: 10.1016/j.ejro.2020.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022] Open
Abstract
Intrahepatic biloma is a rare complication of radiofrequency ablation (RFA). When present, it can only be conservatively managed. Here, we report the case of a patient with hepatocellular carcinoma complicated by an intractable biloma after RFA. The biloma could not be managed via percutaneous catheter drainage and antibiotic administration for over 3 months. The intractable biloma was finally cured using percutaneous transhepatic portal vein embolization. The present case demonstrates a useful treatment option for intractable biloma after RFA.
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