Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma

Anne-Marleen Van Keulen,Stefan Buettner,Marc G Besselink,Olivier R Busch,Thomas M Van Gulik,Jan N.M Ijzermans,Jeroen De Jonge,Wojciech G Polak,Rutger-Jan Swijnenburg,Joris I Erdmann,Bas Groot Koerkamp,Pim B Olthof

doi:10.1016/j.surg.2021.04.013

Anne-Marleen Van Keulen, Stefan Buettner + Show 10 more

Open Access

https://doi.org/10.1016/j.surg.2021.04.013

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Abstract

BackgroundThe aim of this study was to investigate the incidence and risk factors of primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma. MethodsAll patients who underwent a major liver resection for presumed perihilar cholangiocarcinoma between 2000 and 2020 at 2 tertiary-referral hospitals were included. Liver failure was defined according to the International Study Group for Liver Surgery criteria, and only grade B/C was considered clinically relevant. Primary liver failure was defined as failure without any underlying postoperative cause, and secondary liver failure was defined as liver failure with an onset after an underlying postoperative complication as a cause. ResultsThe incidence of liver failure and 90-day mortality were 20.9% and 17.0% in the 253 included patients, respectively. The incidences of primary liver failure was 9.1% and secondary liver failure was 11.9%. Abdominal sepsis, portal vein thrombosis, and arterial thrombosis were the most frequent causes. The absence of preoperative remnant liver assessment and blood loss were independent risk factors for primary liver failure. Independent risk factors for secondary liver failure were Eastern Cooperative Oncology group performance status, percutaneous biliary drainage, and preoperative cholangitis. ConclusionLiver failure after major liver resection for perihilar cholangiocarcinoma occurred in 1 of every 5 patients. The proposed subdivision into primary and secondary liver failure could help to understand differences in outcomes between centers and help to reduce liver failure.

Highlights

Radical resection of perihilar cholangiocarcinoma mostly requires extrahepatic bile duct resection combined with major liver resection.[1,2]
Assessment of future liver remnant function has been performed routinely using HBS using technetium labeled mebrofenin at the Amsterdam UMC, location AMC since 2000.7,13 Computed tomographyevolumetric assessment of the future remnant liver had been performed in conjunction with HBS until 2010, after which volumes were measured in selected patients
At the Erasmus MC, future liver remnant volume assessment was performed for most patients who were scheduled for an extended right hemihepatectomy

Summary

Introduction

Radical resection of perihilar cholangiocarcinoma (pCCA) mostly requires extrahepatic bile duct resection combined with major liver resection.[1,2] The operative risks associated with this type of surgery is among the highest of any elective procedure in oncological surgery. The aim of this study was to investigate the incidence and risk factors of primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma. Methods: All patients who underwent a major liver resection for presumed perihilar cholangiocarcinoma between 2000 and 2020 at 2 tertiary-referral hospitals were included. Results: The incidence of liver failure and 90-day mortality were 20.9% and 17.0% in the 253 included patients, respectively. The incidences of primary liver failure was 9.1% and secondary liver failure was 11.9%. The absence of preoperative remnant liver assessment and blood loss were independent risk factors for primary liver failure. Independent risk factors for secondary liver failure were Eastern Cooperative Oncology group performance status, percutaneous biliary drainage, and preoperative cholangitis. Conclusion: Liver failure after major liver resection for perihilar cholangiocarcinoma occurred in 1 of every 5 patients. The proposed subdivision into primary and secondary liver failure could help to understand differences in outcomes between centers and help to reduce liver failure

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