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A Report of 52 Cases Treated at a Single Institution

Ta-Sen Yeh, MD; Yi-Yin Jan, MD; Long-Bin Jeng, MD; Tsang-Long Hwang, MD; Tzu-Chieh Chao, MD, PhD; Rong-Nan Chien, MD; Miin-Fu Chen, MD, FACS

Arch Surg. 1998;133:242-245.

Background  Prognosis of pyogenic liver abscesses in patients with malignant disease is generally considered poor. The discrepancy between the outcomes of liver abscesses caused by hepatopancreatobiliary malignant disease and those caused by other malignant diseases, however, to our knowledge has never been investigated.

Objectives  To clarify the clinical course of pyogenic liver abscess in patients with different types of cancer, and to compare outcomes in abscesses caused by hepatopancreatobiliary malignant disease and other malignant disease.

Design  Retrospective review of case series in our experience from 1980 through 1993.

Setting  Tertiary care university teaching hospital.

Patients  Fifty-two patients with pyogenic liver abscess related to the underlying cancer were divided into 2 groups. Group 1 (n=32) was composed of patients with cancer originating from the hepatic parenchyma, bile duct, and pancreas; group 2 (n=20) was composed of patients with cancer originating from other sites.

Interventions  Parenteral antibiotics, percutaneous drainage, surgical drainage, or hepatectomy, in combinations, were employed.

Main Outcome Measures  Patient characteristics, symptoms, laboratory data, abscess characteristics, microbiological study, management, and outcome of the 2 groups were analyzed.

Results  Thirteen patients (41%) in group 1 and 16 patients (80%) in group 2 had undergone prior anticancer treatment. Jaundice was encountered more often in group 1 than in group 2 (29 patients [91] vs 6 patients [30], respectively, P=.001), whereas nausea and vomiting were more frequently seen in group 2 than in group 1 (17 patients [52] vs 6 patients[31], respectively, P=.04). Leukocytosis, hypoalbuminemia, hyperbilirubinemia, and reversed albumin-globulin ratio were more pronounced in group 1 than in group 2 (P=.001, .02, .003, and .03, respectively). Abscesses communicating with the intrahepatic biliary tree were more frequently encountered in group 1 than in group 2 (11 patients [34] vs 2 patients [10], respectively, P=.03). Escherichia coli and Klebsiella pneumoniae predominated in group 1, while the bacteria species in group 2 were more diverse. The hospital mortality rates of group 1 and group 2 were 28% (9 of 32 patients) vs 10% (2 of 20 patients) (P=.04), respectively. Twenty-three patients (72%) of group 1 died of uncontrolled biliary sepsis or progressive cancer or both within 6 months after the diagnosis, while 17 patients (85%) of group 2 survived longer than 1 year without relapse of the abscess and continued with anticancer treatment.

Conclusions  Pyogenic liver abscess could be a presentation of hepatopancreatobiliary malignant disease at the preterminal stage, and carries a grave prognosis. Pyogenic liver abscess in patients with nonhepatopancreatobiliary malignant disease has a better chance of favorable outcome.

From the Department of Surgery (Drs Yeh, Jan, Jeng, Hwang, Chao, and Chen) and the Liver Unit (Dr Chien), Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.

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