Risk factors for a high Comprehensive Complication Index score after major hepatectomy for biliary cancer: a study of 229 patients at a single institution

Abstract

Patients who undergo preoperative external biliary drainage for severe jaundice might have impaired production of coagulation factors. When blood loss during liver transection becomes difficult to control, surgeons should consider various strategies, such as second-stage biliary or pancreatic reconstruction. In patients planned to undergo major hepatectomy with combined PD, preoperative portal vein embolization is mandatory to prevent postoperative liver failure.

Trends in indications, complications and outcomes for venous resection during pancreatoduodenectomy

“…In the present study, there was no difference in CCI between the two groups. The CCI has recently been used in large studies of surgical outcomes, and could be a way of reducing discrepancies in the reporting of complications between these groups.…”

Clinicopathological features and prognosis of advanced biliary carcinoma centered in the cystic duct

“…A biliary tumor preoperatively diagnosed as BCCD was treated according to the department's strategy for GBC, as previously reported. 6,7 Briefly, para-aortic lymphadenectomy and pathological examinations of frozen sections proceeded immediately after laparotomy so that radical resection could be converted to a palliative procedure if metastasis to the para-aortic lymph node was identified. 8 A tumor extending into the hepatic hilum and/or Glissonian pedicle was an indication for hepatectomy and resection of the bile duct followed by reconstruction.…”

The effect and safety of preoperative biliary drainage in patients with hilar cholangiocarcinoma: an updated meta-analysis

“…However, the majority of patients with hCCA have no typical symptoms until hCCA progresses enough to obstruct the bile ducts and lead to jaundice, which always presents as the first symptom. Unfortunately, according to several studies, patients with jaundice may experience infections, postoperative hepatic insufficiency, intraoperative blood loss, and renal insufficiency [ 4 – 8 ], and preoperative biliary drainage (PBD) is regarded as a practical solution to reduce the total serum bilirubin (TSB) concentration. However, patients who undergo PBD, mainly by percutaneous transhepatic biliary drainage (PTBD) and endoscopic nasobiliary drainage (ENBD), also have an increased risk for tumor seeding, extended hospital stays, morbidities, and infections [ 1 , 2 , 9 , 10 ].…”