Hepatobiliary cancer and pyogenic liver abscess: when poking the skunk is not enough: invited commentary on Chen, et al. Am J Surg 2013;205:52-7.
Hepatobiliary cancer and pyogenic liver abscess: when poking the skunk is not enough: invited commentary on Chen, et al. Am J Surg 2013;205:52-7.
复制标题
肝胆癌和化脓性肝脓肿：戳臭鼬还不够：陈等人的特邀评论。
DOI：
10.1016/j.amjsurg.2012.06.008
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发表时间：
2013
影响因子：
3
通讯作者：
Behrns,KevinE
中科院分区：
文献类型：
--
作者：
Behrns,KevinE
Patients with hepatobiliary or pancreatic cancer who develop pyogenic liver abscesses (PLAs) are an incredibly complex group of patients. First, these patients often harbor advanced malignancies that are associated with immune suppression. Furthermore, these cancers result frequently in biliary obstruction that can lead to overt or insipid cholangitis and subsequent liver abscess formation. If the cancer or associated obstructed biliary tree is not recognized promptly, patients may develop multiple abscesses or multiloculated abscesses, which are notoriously difficult to treat. In addition, the performance status of these patients is typically poor, and therefore, complicated invasive treatment plans are tolerated poorly. Moreover, data from the past 15 years suggest that the incidence of PLA is increasing, and most of PLAs are associated with cancer. 1, 2 Most of these PLAs are now treated with percutaneous drainage and antibiotics. 3The report by Lai et al4 in this issue adds valuable insight into the treatment of PLAs in patients with hepatobiliary malignancies. In this series of 44 patients with PLAs, treatment with percutaneous drainage failed in 34%. Importantly, the mortality in these 15 patients was an astounding 60%. Twelve of these 15 patients underwent salvage surgery, but only 6 survived. Factors associated with failure of percutaneous drainage on multivariate analysis were multiloculated abscesses and abscesses with biliary communication. The overall mortality for all patients was 32%, which is not surprising, considering that previous work has clearly demonstrated mortality ranging from 5.6% to 33%. 1-3, 5
