Abstract:

Objective

To investigate the causes of spontaneous bile leakage in hepatocellular carcinoma （HCC） patients undergoing hepatectomy after conversion therapy.

Methods

Clinical data of 41 HCC patients who underwent laparoscopic hepatectomy in Nanfang Hospital of Southern Medical University from October 2022 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 31 patients were male and 10 female， aged from 28 to 73 years， with a median age of 60 years.All patients were divided into the conversion therapy group （n=10 cases） and non-conversion therapy group （n=31） according to whether conversion therapy was performed before operation.TACE， hepatic arterial infusion chemotherapy combined with targeted immunotherapy were adopted in the conversion therapy.The operation time and the length of postoperative hospital stay between two groups were compared by Man-Whitney U test.The incidence of bile leakage was compared by Fisher’s exact test.

Results

The incidence of postoperative bile leakage was 40%（4/10）in the conversion therapy group， and no bile leakage was reported in the non-conversion therapy group， and the difference was statistically significant between two groups （P=0.002）.In the conversion therapy group，the operation time was 222 （168，277） min， significantly longer than 146 （99，208） min in the non-conversion therapy group （Z=2.478， P＜0.05）.In the conversion therapy group， the length of postoperative hospital stay and time of indwelling drainage catheter were 11.9 （8.3， 12.8） and 11.0 （8.0， 14.0） d， significantly longer than 8.9 （7.6， 10.4） and 7.0 （4.0， 10.0） d in the non-conversion therapy group （Z=1.372， 2.163， both P＜0.05）.

Pathological examination showed that a large number of inflammatory cells were distributed adjacent to the portal area of liver in the paracancerous （non-surgical margin） tissues of patients after conversion treatment.Severe edema of liver cells and intracellular cholestasis were noted.Bile leakage occurred in the bile duct，and the lumen structure was basically intact.

Conclusions

The increased incidence of bile leakage in HCC patients undergoing radical resection after conversion therapy is probably correlated with the changes of liver tissue structure and texture after conversion therapy.For these patients， the drainage situation should be closely monitored after operation and the time of indwelling drainage catheter should be appropriately prolonged.

Key words: Carcinoma, hepatocellular, Conversion therapy, Bile leakage, Laparoscopic, Hepatectomy