Postoperative mortality after liver resection for perihilar cholangiocarcinoma: Importance of biliary drainage of the future liver remnant and development of a risk score

Abstract

Objective: To assess the effect of biliary drainage of the future liver remnant (FLR) and to develop a risk score for postoperative mortality after liver resection for perihilar cholangiocarcinoma (PHC). Methods: A consecutive series of 287 patients submitted to major liver resection for presumed PHC between 1997 and 2014 at two Western centers was analyzed; 228 patients (79%) underwent preoperative drainage for jaundice. FLR volumes were calculated with CT volumetry, and completeness of FLR drainage was assessed on imaging. A risk score was developed using multivariable logistic regression with five pre-defined variables. Results: Postoperative mortality at 90-days was 14%. Incomplete FLR drainage was a risk factor only in patients with an FLR volume below 50% (OR 2.8, 95% CI 1.1-7.5). No postoperative mortality was observed in 33 undrained patients with FLR volumes above 50%, including 10 jaundiced patients (median bilirubin level 188 mmol/L). Age,

Postoperative peak transaminases correlate with morbidity and mortality after liver resection

“…The discrepancy could be due to the higher number of events in the PHC patients compared to other diagnoses, which increases the statistical power of the AUC analyses. Alternatively, ALT could be a better predictor compared to AST in PHC patients since most of these patients suffer from obstructive cholestasis and jaundice, 23 which could reflect the compromised liver as major determinant of postoperative outcome. 24 Most other patients do not suffer from obstructive jaundice and therefore surgical stress itself might be a bigger factor in these patients resulting in higher predictive value of AST over ALT.…”

Liver resection for cancer: New developments in prediction, prevention and management of postresectional liver failure

“…After extensive resection for perihilar CCA, PLF is seen in up to 30% of patients and mortality occurs in around 8-12% of patients [89,90], possibly due to a combination of cholangitis and a small RLV [91]. A complication rate up to 38% is reported after surgical removal of intrahepatic CCA, with few patients developing PLF and a mortality rate of approximately 1% [92].…”

5-Aminolevulinic-acid-mediated Photodynamic Diagnosis Enhances the Detection of Peritoneal Metastases in Biliary Tract Cancer in Mice

“…Despite these facts, preoperative diagnosis, management, and operative strategies have improved. Major hepatectomy and vascular reconstructions for curative resection of biliary cancers are highly invasive surgeries associated with high morbidity and mortality, with a 5-year survival rate of approximately 40% (1)(2)(3)(4)(5)(6).…”