Postoperative Outcome after Major Liver Resection in Jaundiced Patients with Proximal Bile Duct Cancer without Preoperative Biliary Drainage

Abstract

Background/Aims: The need for routine use of preoperative biliary drainage (PBD) before major liver resection in jaundiced patients has recently been questioned. Our aim was to present our experience of patients with proximal bile duct cancer who undergo major liver resection without PBD and compare these results with patients without biliary obstruction who underwent major liver resection. Methods: Eighty six consecutive jaundiced patients underwent major liver resection without PBD. The postoperative outcome was compared to the control group, which was the same size and matched. Design: A case-comparison study. Results: Fifty nine jaundiced patients (69%) and 22 non-jaundiced patients (25%) received blood transfusion (p = 0.04). Fifty-three patients (62%) in the jaundiced group and 17 (19%) in the non-jaundiced patients experienced postoperative complications (p = 0.003). A statistically significant difference could not be detected for mortality (6 vs. 2%) and transient liver failure (10 vs. 3%). Those patients who underwent extended right hemihepatectomy (with future liver remnant <50%) express high morbidity (55 vs. 24%; p = 0.04) and mortality (23 vs. 8%; p = 0.001) compared to the non-jaundiced patients. Conclusions: Major liver resection without PBD leaving a liver remnant of more than 50% is safe in jaundiced patients. However, transfusion requirement and morbidity are higher in jaundiced patients than in non-jaundiced patients.

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

“…A study involving 287 patients at Memorial Sloan Kettering Cancer Centre and the Academic Medical Centre in Amsterdam also showed improved outcomes after PBD in patients with an FLR < 30%[ 99 ]. Major liver resection in 86 jaundiced patients without PBD with a predicted FLR of < 50% was associated with higher morbidity (55% vs 24%, P = 0.04), mortality (23% vs 8%, P = 0.001) and postoperative complications (62% vs 19%, P = 0.003)[ 112 ]. A meta-analysis assessing the efficacy of PBD in resectable hCCA involving 2162 patients favored PBD in patients with cholangitis, malnutrition (serum albumin < 3 g/dL), prolonged jaundice and high serum bilirubin levels ≥ 15 mg/dL[ 113 ].…”

Dynamic changes of portal vein pressure gradient under different degrees of liver cirrhosis and resection volume in the first week post hepatectomy

“…With improvements in resection techniques and the control of bleeding, the operative mortality for major liver resection (LR) has significantly decreased over the past several decades . Liver resection has evolved to focus on the selection strategy for space‐occupying hepatobiliary diseases, such as tumors, calculus of intrahepatic duct, and hepatic echinococcosis.…”

Prostaglandin E1 Preconditioning Attenuates Liver Ischemia Reperfusion Injury in a Rat Model of Extrahepatic Cholestasis

“…Preoperative biliary drainage has been shown to reduce hepatic IR after ischemia in the animal study [ 4 ]. However, there is still controversy in clinic about the risks and benefits of preoperative biliary drainage [ 6 – 8 ].…”