SAN ANTONIO, TX - Researchers at this week’s meeting of the Society of Cardiovascular and Interventional Radiology are reporting that problematic liver abscesses that form as a result of hepatic chemoembolization procedures almost always occur in patients who had previous Whipple operations.
The Whipple involves the removal of the head of the pancreas in an attempt to cure patients with early-stage pancreatic cancer. The procedure had been performed in seven patients in a retrospective look at abscess formation -- and six of those patients had liver abscesses, said Dr. Woojin Kim, a postdoctoral student at University of Pennsylvania, Philadelphia.
Kim studied 157 patients who had undergone 397 chemoembolization procedures, and found that seven of the patients had the abscess, one of which resulted in the placement of a permanent drain due to a non-healing biliary fistula. The others required percutaneous drainage for one to nine weeks before they healed. The abscesses appeared about 13-16 days following the chemoembolization procedure.
Only one patient who had an abscess did not have a Whipple; only one patient who had a Whipple did not have an abscess, Kim said. "We find that having a prior Whipple or bilioenteric procedure is the major risk factor for formation of liver abscesses in chemoembolizations," Kim said.
Kim noted that even though the patients were treated prophylactically with antibiotics, the patients with the abscesses were still colonized with a variety of bacteria, mainly Gram-positive species.
Dr. Marshall Hicks of the University of Texas MD Anderson Cancer Center in Houston said that the study points out the need for greater prophylactic antibiotic coverage of patients undergoing chemoembolization procedures, possibly with antibiotics that are more potent against Gram-positive organisms. "I would suggest that when performing these procedures, you should get the hospital infectious disease people involved to make sure that prophylactic antibiotic use is sufficient," he said.
Hicks said that Kim's study was limited by the fact that it was a retrospective look into the causes of abscess formation. He suggested that it might be possible that some people with risk factors aside from the Whipple procedure might have been excluded from the study population. He also noted that the study did show that the complication is infrequent and that fatalities occurring from the procedure are rare.
In his presentation, Kim said that about 4.5% of patients who had chemoembolization for treatment of liver metastases or for primary liver cancer had abscesses. That translated to about 2% of the number of chemoembolizations performed. He said that the odds ratio of having a liver abscess if the patient had a bilioenteric anastomosis was an astounding 894, which was considered highly statistically significant to the p<0001 level.
By Edward Susman
AuntMinnie.com contributing writer
March 5, 2001
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