ORIGINAL ARTICLE Clinical Outcomes and Prognostic Factors of Cancer Patients with Pyogenic Liver Abscess Shiuan-Chih Chen & Yuan-Ti Lee & Shih-Jei Tsai & Kuang-Chi Lai & Chi-Chou Huang & Po-Hui Wang & Chun-Chieh Chen & Meng-Chih Lee Received: 12 April 2011 /Accepted: 26 July 2011 /Published online: 9 August 2011 # 2011 The Society for Surgery of the Alimentary Tract Abstract Purpose Pyogenic liver abscess (PLA) of cancer patients often has a poor prognosis, but corresponding prognostic factors are less investigated. This study aimed to identify predictors of mortality in cancer patients with PLA. Patients and Methods Medical records of 85 consecutive cancer patients (46 with hepatobiliary pancreatic cancer, 14 with gastrointestinal cancer, and 25 with non-digestive system cancer) having PLA who were admitted to two university hospitals were retrospectively reviewed. The predictors of mortality were determined using Cox regression model. Results The overall case fatality rate was 33%. In multivariate analysis, the greater Acute Physiology and Chronic Health Evaluation II score (P=0.028), multiloculated abscess (P=0.025), and polymicrobial infection (P=0.003) were associated with mortality. In subgroup analysis of the 25 patients with multiloculated abscess undergoing percutaneous catheter drainage as primary treatment, the case fatality rates of patients with a solitary smaller abscess (size<5 cm), those with a solitary larger abscess (size>5 cm), and those with larger multiple abscesses were 0%, 36%, and 85%, respectively (P= 0.002; using χ 2 for trend). Conclusions The advanced disease stage, multiloculated abscess, and polymicrobial infection posed a greater mortality risk in cancer patients with PLA. Moreover, an early surgical approach should be considered for cancer patients having large, multiloculated complex PLAs. S.-C. Chen : Y.-T. Lee : S.-J. Tsai : K.-C. Lai : P.-H. Wang : M.-C. Lee Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan S.-C. Chen : Y.-T. Lee : S.-J. Tsai : C.-C. Huang : P.-H. Wang : C.-C. Chen School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan K.-C. Lai Department of Surgery, China Medical University Hospital and China Medical University Beigang Hospital, Beigang, Taiwan K.-C. Lai School of Medicine, China Medical University, Taichung 40447, Taiwan C.-C. Huang Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan Y.-T. Lee Division of Infectious Diseases, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan S.-C. Chen : C.-C. Chen (*) : M.-C. Lee Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan e-mail: sp954455@seed.net.tw J Gastrointest Surg (2011) 15:2036–2043 DOI 10.1007/s11605-011-1650-3