Risk factors of intrahepatic biloma and secondary infection after thermal ablation for malignant hepatic tumors

Abstract

Objective: This study aimed to evaluate the risk factors of biloma formation and secondary infection after thermal ablation for malignant hepatic tumors.

Patients and methods: A total of 58 patients with 68 bilomas after thermal ablation were recruited as the complication group, and 61 patients with 72 lesions without major complications were selected randomly as the control group. The potential risk factors for biloma formation were analyzed with the chi-square test and multivariate logistic regression analysis. To determine the optimum management method for biloma, patients with secondary infection were included for the subgroup analysis of risk factors.

Results: A history of transcatheter arterial chemoembolization (TACE) treatment (odds ratio [OR]: 3.606, 95% confidence interval [CI]: 1.165–11.156, p = .026) and tumor location (OR: 37.734, 95% CI: 13.058–109.034, p = .000) were independent predictors of biloma formation. Among the 58 patients with biloma, 49 (84.5%) showed no symptoms (i.e., the asymptomatic group), while the remaining 9 (15.5%) developed symptoms related to secondary infections (i.e., the symptomatic group). There were significant differences in the history of biliary manipulation (p = .031) between the symptomatic and asymptomatic groups.

Conclusion: A history of TACE treatment and the distance from the biliary tract were independent predictors of biloma formation after thermal ablation. Therefore, protecting the bile duct (i.e., cooling of the bile duct and combing thermal ablation with chemical ablation) should be considered for high-risk patients. Moreover, active monitoring and management should be performed for patients with bilomas who underwent biliary surgery before.

Keywords:

• Malignant hepatic tumor
• biloma
• infection
• risk factor
• thermal ablation

Disclosure statement

The authors declare no conflicts of interest.

Additional information

Funding

This work was supported by the National Key Research and Development Program of China under Grant No. 2017YFC0112000; Science and Technology Planning Program of Guangzhou, China under Grant No. 201704020164; Science and Technology Planning Project of Guangdong Province, China under Grant No. 2017A020215137, 2017A020215082 and 2017B090901034; and Research Fund for Young Teacher Training Project of Sun Yat-Sen University under Grant No. 18ykpy05.