Liver Abscesses: Factors That Influence Outcome of Percutaneous Drainage.
AJR Am J Roentgenol. 2017 Jul;209(1):205-213. doi: 10.2214/AJR.16.17713. Epub 2017 May 15. Haider SJ1, Tarulli M2, McNulty NJ3, Hoffer EK3.
OBJECTIVE: The purpose of this study was to identify the details of percutaneous catheter drainage (PCD) of pyogenic liver abscesses, the etiologic factors, and the management techniques that contribute to successful treatment.
MATERIALS AND METHODS: The records of 75 consecutively registered patients who underwent PCD of 96 abscesses at a single institution between May 2009 and May 2014 were retrospectively reviewed. Thirty-nine patients (52%) were oncology patients, and 36 (48%) had recently undergone abdominal surgery. Primary success was defined as abscess healing with the primary PCD intervention and 30-day postdrainage survival. Salvage success was defined as abscess healing with follow-up secondary PCD placement for symptomatic hepatic satellite collections or for clinical recurrence. Catheter adjustments were performed during follow-up to optimize existing drains. Univariate, multivariate, and general linear mixed model analyses were performed. The median follow-up time after catheter removal was 6 months (range, 2-62 months).
RESULTS: Drains were primarily successful in 54 patients (72%), and 17 patients (23%) needed salvage PCD; thus, overall success was achieved in 71 patients (95%). The other four patients (5%) died of sepsis. The primary success rate was reduced in patients with unresectable malignancies (p = 0.01), multiple abscesses (p = 0.01), and output ≥ 15 mL/d at catheter endpoint (n = 7, p = 0.001). Only unresectable malignancies had slightly lower overall success. Large abscesses (> 150 cm3) required more catheter adjustments and longer drainage duration to reach abscess cavity closure. Successfully drained abscesses reached cavity closure a mean of 23 days (95% CI, 20-27 days) after treatment.
CONCLUSION: PCD was effective first-line treatment of complicated pyogenic liver abscesses, which often require catheter adjustment and salvage drainage procedures to reliably achieve success.