Prevention of bile leakage after hepatectomy for hepatocellular carcinoma and application of Peng’s leakage test technology_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

MO Shutian ^1,2,3 ,  PENG Tao ^1,2,3

1. Department of Hepatobiliary Surgery, The First Affiliated Hospital, Guangxi Medical University, Nanning 530021, P. R. China;
2. Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, P. R. China;
3. Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, Nanning 530021, P. R. China;

Corresponding?author：

PENG Tao, Email: p98720p@163.com

Keywords：

bile leakage; hepatectomy; hepatocellular carcinoma

DOI：

10.7507/1007-9424.202303028

Video：

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Bile leakage is a common complication of hepatocellular carcinoma (HCC) after hepatectomy, which affects the prognosis and medical quality. It is emphasized that taking preventive measures according to the etiology and related risk factors could help to reduce the incidence of bile leakage, improve the quality and safety of HCC diagnosis and treatment, and achieve the main indicators of HCC quality control in the 2022 version of National Cancer Center. In this review, combined with the team of Peng’s leakage test technology research and clinical practice, brief talk about personal experience.

Citation： MO Shutian, PENG Tao. Prevention of bile leakage after hepatectomy for hepatocellular carcinoma and application of Peng’s leakage test technology. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(6): 641-645. doi: 10.7507/1007-9424.202303028 Copy

1.	國家癌癥中心, 國家腫瘤質控中心肝癌質控專家委員會. 中國肝癌規范診療質量控制指標(2022版). 肝癌電子雜志, 2022, 9(4): 1-11.
2.	Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J National Cancer Center, 2022, 2(1): 1-9.
3.	Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4.	Shankaran V, Chennupati S, Sanchez H, et al. Clinical characteristics, treatment patterns, and healthcare costs and utilization for hepatocellular carcinoma (HCC) patients treated at a large referral center in washington state 2007-2018. J Hepatocell Carcinoma, 2021, 8: 1597-1606.
5.	Yamashita Y, Tsuijita E, Takeishi K, et al. Trends in surgical results of hepatic resection for hepatocellular carcinoma: 1 000 consecutive cases over 20 years in a single institution. Am J Surg, 2014, 207(6): 890-896.
6.	Jin S, Fu Q, Wuyun G, et al. Management of post-hepatectomy complications. World J Gastroenterol, 2013, 19(44): 7983-7991.
7.	Zheng SM, Li H, Li GC, et al. Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy. ANZ J Surg, 2017, 87(7-8): E26-E31. doi: 10.1111/ans.13073.
8.	Mohkam K, Farges O, Vibert E, et al. Risk score to predict biliary leakage after elective liver resection. Br J Surg, 2018, 105(1): 128-139.
9.	Koch M, Garden O J, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
10.	劉飛, 李海, 巫強. 無膽道重建肝切除術后膽漏危險因素的Meta分析. 臨床肝膽病雜志, 2022, 38(3): 594-600.
11.	馬斌, 湯光耀, 王麟, 等. 預測肝細胞癌肝切除術后膽漏的獨立危險因素. 醫學食療與健康, 2018, (12): 72.
12.	Fischer A, Fuchs J, Stravodimos C, et al. Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk? BMC Surg, 2020, 20(1): 305. doi: 10.1186/s12893-020-00971-w.
13.	Martin AN, Narayanan S, Turrentine FE, et al. Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection. J Gastrointest Surg, 2018, 22(4): 661-667.
14.	Spetzler VN, Schepers M, Pinnschmidt HO, et al. The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr, 2019, 8(2): 101-110.
15.	Braunwarth E, Primavesi F, Göbel G, et al. Is bile leakage after hepatic resection associated with impaired long-term survival? Eur J Surg Oncol, 2019, 45(6): 1077-1083.
16.	董家鴻. 精準肝臟外科學. 北京: 清華大學出版社, 2021: 422-445.
17.	謝海翔, 韓創業, 彭凱, 等. 肝動脈灌注化療聯合免疫靶向新輔助治療單發CNLC Ⅰ b期肝細胞癌的安全性與療效分析. 中華肝膽外科雜志, 2023, 29(1): 28-33.
18.	高偉, 吳昊鈞, 魏波, 等. 肝細胞癌合并門靜脈癌栓聯合肝靜脈栓塞介入轉化縮小病肝體積后行吲哚菁綠輔助腹腔鏡右半肝切除1例報告. 中國普外基礎與臨床雜志, 2023, 30(2): 221-223.
19.	Karoui M, Penna C, Amin-hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg, 2006, 243(1): 1-7.
20.	Inoue Y, Imai Y, Fujii K, et al. The utility of 5-aminolevulinic acid-mediated photodynamic diagnosis in the detection of intraoperative bile leakage. Am J Surg, 2017, 213(6): 1077-1082.
21.	Trehan V, Rao PP, Naidu CS, et al. Hydrogen peroxide test for intraoperative bile leak detection. Med J Armed Forces India, 2017, 73(3): 256-260.
22.	Ma JY, Li XF, Yan ZL, et al. Randomized Controlled Trial of Hepatic Portal Reocclusion as a New Option for Detecting Bile Leakage during Hepatic Resection. Dig Surg, 2017, 34(4): 328-334.
23.	Zimmitti G, Vauthey J N, Shindoh J, et al. Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Coll Surg, 2013, 217(6): 1028-1037.
24.	Maulat C, Regimbeau J M, Buc E, et al. Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial. Br J Surg, 2020, 107(7): 824-831.
25.	Nanashima A, Abo T, Shibuya A, et al. Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak? HPB (Oxford), 2013, 15(7): 517-522.
26.	Nanashima A, Tobinaga S, Abo T, et al. Usefulness of omental wrapping to prevent biliary leakage and delayed gastric emptying in left hepatectomy. Hepatogastroenterology, 2012, 59(115): 847-850.
27.	Paquet JC, Dziri C, Hay JM, et al. Prevention of deep abdominal complications with omentoplasty on the raw surface after hepatic resection. The French Associations for Surgical Research. Am J Surg, 2000, 179(2): 103-109.
28.	Mo S, He Y, Zhu G, et al. A novel Peng's test in reducing bile leakage after partial hepatectomy for hepatocellular carcinoma: From an animal study to a clinical cohort Propensity score matching comparative study. Int J Surg, 2022, 104: 106748. doi: 10.1016/j.ijsu.2022.106748.
29.	李源. 術中美藍試驗降低肝切除術后膽漏并發癥的臨床研究—廣西醫科大學第一附屬醫院107例肝切除術臨床病例分析. 廣西醫科大學, 2014.
30.	翟中山. 肝R0切除術后發生膽漏危險因素的多元回歸分析. 肝臟, 2015, 20(5): 404-407.
31.	郭兵, 許曉磊, 韓軍偉, 等. 肝切除術后膽漏研究進展. 河北醫藥, 2020, 42(23): 3639-3644.
32.	Yoshimoto H, Ikeda S, Tanaka M, et al. Relationship of biliary pressure to cholangiovenous reflux during endoscopic retrograde balloon catheter cholangiography. Dig Dis Sci, 1989, 34(1): 16-20.
33.	Huang T, Bass J A, Williams R D. The significance of biliary pressure in cholangitis. Arch Surg, 1969, 98(5): 629-632.
34.	Ijichi M, Takayama T, Toyoda H, et al. Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg, 2000, 135(12): 1395-1400.
35.	周訓蓉, 李江萍. 亞甲藍的化學、藥理研究及臨床應用進展. 中國藥業, 2008, 215(4): 62-64.
36.	Gomes TF, Pedrosa MM, De Toledo ACL, et al. Bactericide effect of methylene blue associated with low-level laser therapy in Escherichia coli bacteria isolated from pressure ulcers. Lasers Med Sci, 2018, 33(8): 1723-1731.
37.	Mccartney SL, Duce L, Ghadimi K. Intraoperative vasoplegia: methylene blue to the rescue! Curr Opin Anaesthesiol, 2018, 31(1): 43-49.

1. 國家癌癥中心, 國家腫瘤質控中心肝癌質控專家委員會. 中國肝癌規范診療質量控制指標(2022版). 肝癌電子雜志, 2022, 9(4): 1-11.
2. Zheng R, Zhang S, Zeng H, et al. Cancer incidence and mortality in China, 2016. J National Cancer Center, 2022, 2(1): 1-9.
3. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
4. Shankaran V, Chennupati S, Sanchez H, et al. Clinical characteristics, treatment patterns, and healthcare costs and utilization for hepatocellular carcinoma (HCC) patients treated at a large referral center in washington state 2007-2018. J Hepatocell Carcinoma, 2021, 8: 1597-1606.
5. Yamashita Y, Tsuijita E, Takeishi K, et al. Trends in surgical results of hepatic resection for hepatocellular carcinoma: 1 000 consecutive cases over 20 years in a single institution. Am J Surg, 2014, 207(6): 890-896.
6. Jin S, Fu Q, Wuyun G, et al. Management of post-hepatectomy complications. World J Gastroenterol, 2013, 19(44): 7983-7991.
7. Zheng SM, Li H, Li GC, et al. Risk factors, treatment and impact on outcomes of bile leakage after hemihepatectomy. ANZ J Surg, 2017, 87(7-8): E26-E31. doi: 10.1111/ans.13073.
8. Mohkam K, Farges O, Vibert E, et al. Risk score to predict biliary leakage after elective liver resection. Br J Surg, 2018, 105(1): 128-139.
9. Koch M, Garden O J, Padbury R, et al. Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery, 2011, 149(5): 680-688.
10. 劉飛, 李海, 巫強. 無膽道重建肝切除術后膽漏危險因素的Meta分析. 臨床肝膽病雜志, 2022, 38(3): 594-600.
11. 馬斌, 湯光耀, 王麟, 等. 預測肝細胞癌肝切除術后膽漏的獨立危險因素. 醫學食療與健康, 2018, (12): 72.
12. Fischer A, Fuchs J, Stravodimos C, et al. Influence of diabetes on short-term outcome after major hepatectomy: an underestimated risk? BMC Surg, 2020, 20(1): 305. doi: 10.1186/s12893-020-00971-w.
13. Martin AN, Narayanan S, Turrentine FE, et al. Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection. J Gastrointest Surg, 2018, 22(4): 661-667.
14. Spetzler VN, Schepers M, Pinnschmidt HO, et al. The incidence and severity of post-hepatectomy bile leaks is affected by surgical indications, preoperative chemotherapy, and surgical procedures. Hepatobiliary Surg Nutr, 2019, 8(2): 101-110.
15. Braunwarth E, Primavesi F, Göbel G, et al. Is bile leakage after hepatic resection associated with impaired long-term survival? Eur J Surg Oncol, 2019, 45(6): 1077-1083.
16. 董家鴻. 精準肝臟外科學. 北京: 清華大學出版社, 2021: 422-445.
17. 謝海翔, 韓創業, 彭凱, 等. 肝動脈灌注化療聯合免疫靶向新輔助治療單發CNLC Ⅰ b期肝細胞癌的安全性與療效分析. 中華肝膽外科雜志, 2023, 29(1): 28-33.
18. 高偉, 吳昊鈞, 魏波, 等. 肝細胞癌合并門靜脈癌栓聯合肝靜脈栓塞介入轉化縮小病肝體積后行吲哚菁綠輔助腹腔鏡右半肝切除1例報告. 中國普外基礎與臨床雜志, 2023, 30(2): 221-223.
19. Karoui M, Penna C, Amin-hashem M, et al. Influence of preoperative chemotherapy on the risk of major hepatectomy for colorectal liver metastases. Ann Surg, 2006, 243(1): 1-7.
20. Inoue Y, Imai Y, Fujii K, et al. The utility of 5-aminolevulinic acid-mediated photodynamic diagnosis in the detection of intraoperative bile leakage. Am J Surg, 2017, 213(6): 1077-1082.
21. Trehan V, Rao PP, Naidu CS, et al. Hydrogen peroxide test for intraoperative bile leak detection. Med J Armed Forces India, 2017, 73(3): 256-260.
22. Ma JY, Li XF, Yan ZL, et al. Randomized Controlled Trial of Hepatic Portal Reocclusion as a New Option for Detecting Bile Leakage during Hepatic Resection. Dig Surg, 2017, 34(4): 328-334.
23. Zimmitti G, Vauthey J N, Shindoh J, et al. Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications. J Am Coll Surg, 2013, 217(6): 1028-1037.
24. Maulat C, Regimbeau J M, Buc E, et al. Prevention of biliary fistula after partial hepatectomy by transcystic biliary drainage: randomized clinical trial. Br J Surg, 2020, 107(7): 824-831.
25. Nanashima A, Abo T, Shibuya A, et al. Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak? HPB (Oxford), 2013, 15(7): 517-522.
26. Nanashima A, Tobinaga S, Abo T, et al. Usefulness of omental wrapping to prevent biliary leakage and delayed gastric emptying in left hepatectomy. Hepatogastroenterology, 2012, 59(115): 847-850.
27. Paquet JC, Dziri C, Hay JM, et al. Prevention of deep abdominal complications with omentoplasty on the raw surface after hepatic resection. The French Associations for Surgical Research. Am J Surg, 2000, 179(2): 103-109.
28. Mo S, He Y, Zhu G, et al. A novel Peng's test in reducing bile leakage after partial hepatectomy for hepatocellular carcinoma: From an animal study to a clinical cohort Propensity score matching comparative study. Int J Surg, 2022, 104: 106748. doi: 10.1016/j.ijsu.2022.106748.
29. 李源. 術中美藍試驗降低肝切除術后膽漏并發癥的臨床研究—廣西醫科大學第一附屬醫院107例肝切除術臨床病例分析. 廣西醫科大學, 2014.
30. 翟中山. 肝R0切除術后發生膽漏危險因素的多元回歸分析. 肝臟, 2015, 20(5): 404-407.
31. 郭兵, 許曉磊, 韓軍偉, 等. 肝切除術后膽漏研究進展. 河北醫藥, 2020, 42(23): 3639-3644.
32. Yoshimoto H, Ikeda S, Tanaka M, et al. Relationship of biliary pressure to cholangiovenous reflux during endoscopic retrograde balloon catheter cholangiography. Dig Dis Sci, 1989, 34(1): 16-20.
33. Huang T, Bass J A, Williams R D. The significance of biliary pressure in cholangitis. Arch Surg, 1969, 98(5): 629-632.
34. Ijichi M, Takayama T, Toyoda H, et al. Randomized trial of the usefulness of a bile leakage test during hepatic resection. Arch Surg, 2000, 135(12): 1395-1400.
35. 周訓蓉, 李江萍. 亞甲藍的化學、藥理研究及臨床應用進展. 中國藥業, 2008, 215(4): 62-64.
36. Gomes TF, Pedrosa MM, De Toledo ACL, et al. Bactericide effect of methylene blue associated with low-level laser therapy in Escherichia coli bacteria isolated from pressure ulcers. Lasers Med Sci, 2018, 33(8): 1723-1731.
37. Mccartney SL, Duce L, Ghadimi K. Intraoperative vasoplegia: methylene blue to the rescue! Curr Opin Anaesthesiol, 2018, 31(1): 43-49.

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Prevention of bile leakage after hepatectomy for hepatocellular carcinoma and application of Peng’s leakage test technology

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