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.	国家癌症中心, 国家肿瘤质控中心肝癌质控专家委员会. 中国肝癌规范诊疗质量控制指标(2022版). 肝癌电子杂志, 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.	刘飞, 李海, 巫强. 无胆道重建肝切除术后胆漏危险因素的Meta分析. 临床肝胆病杂志, 2022, 38(3): 594-600.
11.	马斌, 汤光耀, 王麟, 等. 预测肝细胞癌肝切除术后胆漏的独立危险因素. 医学食疗与健康, 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.	董家鸿. 精准肝脏外科学. 北京: 清华大学出版社, 2021: 422-445.
17.	谢海翔, 韩创业, 彭凯, 等. 肝动脉灌注化疗联合免疫靶向新辅助治疗单发CNLC Ⅰ b期肝细胞癌的安全性与疗效分析. 中华肝胆外科杂志, 2023, 29(1): 28-33.
18.	高伟, 吴昊钧, 魏波, 等. 肝细胞癌合并门静脉癌栓联合肝静脉栓塞介入转化缩小病肝体积后行吲哚菁绿辅助腹腔镜右半肝切除1例报告. 中国普外基础与临床杂志, 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. 术中美蓝试验降低肝切除术后胆漏并发症的临床研究—广西医科大学第一附属医院107例肝切除术临床病例分析. 广西医科大学, 2014.
30.	翟中山. 肝R0切除术后发生胆漏危险因素的多元回归分析. 肝脏, 2015, 20(5): 404-407.
31.	郭兵, 许晓磊, 韩军伟, 等. 肝切除术后胆漏研究进展. 河北医药, 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.	周训蓉, 李江萍. 亚甲蓝的化学、药理研究及临床应用进展. 中国药业, 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. 国家癌症中心, 国家肿瘤质控中心肝癌质控专家委员会. 中国肝癌规范诊疗质量控制指标(2022版). 肝癌电子杂志, 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. 刘飞, 李海, 巫强. 无胆道重建肝切除术后胆漏危险因素的Meta分析. 临床肝胆病杂志, 2022, 38(3): 594-600.
11. 马斌, 汤光耀, 王麟, 等. 预测肝细胞癌肝切除术后胆漏的独立危险因素. 医学食疗与健康, 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. 董家鸿. 精准肝脏外科学. 北京: 清华大学出版社, 2021: 422-445.
17. 谢海翔, 韩创业, 彭凯, 等. 肝动脉灌注化疗联合免疫靶向新辅助治疗单发CNLC Ⅰ b期肝细胞癌的安全性与疗效分析. 中华肝胆外科杂志, 2023, 29(1): 28-33.
18. 高伟, 吴昊钧, 魏波, 等. 肝细胞癌合并门静脉癌栓联合肝静脉栓塞介入转化缩小病肝体积后行吲哚菁绿辅助腹腔镜右半肝切除1例报告. 中国普外基础与临床杂志, 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. 术中美蓝试验降低肝切除术后胆漏并发症的临床研究—广西医科大学第一附属医院107例肝切除术临床病例分析. 广西医科大学, 2014.
30. 翟中山. 肝R0切除术后发生胆漏危险因素的多元回归分析. 肝脏, 2015, 20(5): 404-407.
31. 郭兵, 许晓磊, 韩军伟, 等. 肝切除术后胆漏研究进展. 河北医药, 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. 周训蓉, 李江萍. 亚甲蓝的化学、药理研究及临床应用进展. 中国药业, 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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