Posthepatectomy liver failure in patients with perihilar cholangiocarcinoma

Abstract

Introduction: Posthepatectomy liver failure (PHLF) after radical treatment of perihilar cholangiocarcinoma (PHCC) is still high. We aimed to evaluate the factors affecting PHLF after radical resections for PHCC. Method: From October 2013 to December 2018, 100 patients underwent radical resection with intention-to-treat. Open and minimally invasive (laparoscopic and robot-assisted) resection with regional lymphadenectomy D2 were performed. Mann-Whitney U-test was used for statistical analysis. Result: Three patients were treated for benign strictures (PHCC was not confirmed on pathology). Further, only patients with PHCC were included analyzed. Demographic and perioperative data: female/male ratio 51/46; mean age 60 (35-80) year; ASA 4 (2-5); acute cholangitis after biliary drainage 56 (58%); portal vein embolization 22 (23%); vascular reconstruction 32 (33%); blood loss 505 (50-2500) mL; operation time 567 (290-985) min. PHLF took place in 19 (20%) of patients, including 11 and 8 cases of grade B and C (ISGLS), respectively. The whole mortality was 16 (16%); mortality in PHLF group was 5 (31%). Severe morbidity (>II Clavien-Dindo) was registered in 77 (79%) patients. R0 resection rate was 85%; hospital stay 24 (3-73) day. Portal vein embolization (PVE) was performed in 24 patients (25%). The influence of 22 factors on the risk of PHLF was analyzed. PHLF significantly dependent on blood loss (p=0,033), blood transfusion (p=0,017), resection of >3 liver segments (p=0,045). PHLF did not significantly increase the hospital stay. Conclusion: The high risk of PHLF should be considered after major liver resection and large blood loss. PVE in case of small future liver remnant and effective treatment of preoperative cholangitis are necessary to reduce the risk of PHLF.