Preoperative biliary drainage reduce postoperative liver failure on patients undergoing major liver resection for perihiliar colangiocarcinoma

Abstract

Background: Preoperative jaundice in liver surgery could be deleterious for major liver resection (MLR). Preoperative biliary drainage (PBD) is recommended in order to improve liver function, reduce morbidity and avoid postoperative liver failure (POLF). Our aim is to evaluate the role of PBD in the incidence of POLF in patients undergoing a MLR due to perihiliar cholangiocarcinoma (PHC). Methods: A retrospective cohort of 42 patients with PHC who were submitted to MLR between 2000 to June 2015 were included for the analysis. PBD was performed for reduce Total Bilirrubin (TB) previous to surgery. Succesful PBD was defined as TB<3 mg/dl. Results: Median age 64 years. Thirty one (73.8%) were male. Fourty (95%) were jaundiced at the time of diagnosis. Thirty four (81%) underwent a PBD and 16 (55.8%) of them had a successful drainage, with TB < 3mg/dl, previous MLR. Sixteen (38%) were submitted to an extended liver resection. Eight (19%) patients developed POLF and was associatted with TB >3 mg/dl at the time of the intervention (p< 0,001). Postoperative mortality at 90 days ocurred in 9 in the (TB >3 mg/dl) while only 1 in the other group (TB <3 mg/dl). Conclusion: This study shows the benefit of preoperative biliary drainage, significantly decreasing morbidity and mortality associated to POLF. At the same time confirms as in other studies that the aim of this preoperative procedure should be to obtain a preoperative TB lower than 3 mg/dl.