Preoperative Biliary Drainage Is Associated with Increased Complications After Liver Resection for Proximal Cholangiocarcinoma

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2018 Jul 8

PMID 29980975

Citations 14

Authors

Rajesh Ramanathan

Jeffrey Borrebach

Samer Tohme

Allan Tsung

Affiliations

Soon will be listed here.

Abstract

Background: Preoperative biliary drainage (PBD) prior to liver resection for hilar and intrahepatic cholangiocarcinoma (CCA) is common. While PBD for those with distal obstructions has been studied extensively and is associated with increased infectious complications, the impact of PBD among patients undergoing hepatectomy for non-disseminated proximal CCA has yet to be clearly elucidated.

Methods: Patients undergoing liver resection between 2014 and 2016 for non-disseminated hilar and intrahepatic CCA were analyzed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Associations between PBD (percutaneous or endoscopic) and 30-day outcomes were evaluated.

Results: There were 905 liver resections performed, with 186 (20.6%) for hilar CCA and 719 (79.4%) for intrahepatic CCA. Of those, 251/897 (28.0%) patients underwent PBD. Independent preoperative predictors of PBD were hilar CCA, major hepatectomy, open surgery, lower BMI, and higher preoperative bilirubin. Adjusting for preoperative variables, extent of resection, and bilirubin, PBD was independently associated with increased wound infection (OR 2.93), organ space infection (OR 3.63), sepsis (OR 3.17), renal insufficiency (OR 4.25), transfusion (OR 2.40), bile leak (OR 3.23), invasive intervention (OR 2.72), liver failure (OR 3.20), readmission (OR 3.01), reoperation (OR 2.32), and mortality (OR 4.24, all p < 0.05).

Conclusions: Among patients undergoing hepatectomy for proximal CCA, PBD is associated with increased postoperative complications. These data suggest that avoidance of routine preoperative biliary drainage may decrease short-term complications.

Citing Articles

Time to Surgery Does Not Affect the Survival Outcome in Patients with Perihilar Cholangiocarcinoma.

Tohmatsu Y, Ohgi K, Ashida R, Yamada M, Otsuka S, Kato Y Ann Surg Oncol. 2024; 32(3):1808-1816.

PMID: 39633168 DOI: 10.1245/s10434-024-16628-4.

Total laparoscopic radical resection of hilar cholangiocarcinoma: preliminary experience of a single center.

Du Y, Wang J, Liu L, Ma H, Zhao W, Li Y BMC Surg. 2024; 24(1):241.

PMID: 39182023 PMC: 11344452. DOI: 10.1186/s12893-024-02533-w.

Persistent hyperbilirubinemia following preoperative biliary stenting in patients undergoing anatomic hepatectomy predicts serious complications.

Kirkland M, Verhoeff K, Jogiat U, Mocanu V, Shapiro A, Anderson B Surg Endosc. 2024; 38(8):4287-4295.

PMID: 38872019 DOI: 10.1007/s00464-024-10968-8.

Dynamic three-dimensional liver volume assessment of liver regeneration in hilar cholangiocarcinoma patients undergoing hemi-hepatectomy.

Zhao H, Li B, Li X, Lv X, Guo T, Dai Z Front Oncol. 2024; 14:1375648.

PMID: 38706591 PMC: 11067054. DOI: 10.3389/fonc.2024.1375648.

Role of ablation therapy in conjunction with surgical resection for neuroendocrine tumors involving the liver.

Ostapenko A, Stroever S, Eyasu L, Kim M, Aploks K, Dong X World J Gastrointest Surg. 2024; 16(3):768-776.

PMID: 38577070 PMC: 10989351. DOI: 10.4240/wjgs.v16.i3.768.

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