Retrospective non-inferiority study of preoperative bilirubin level on surgical outcomes in hepatectomy with hilar resection

Abstract

Elevated preoperative bilirubin affects the morbidity and mortality significantly in biliary tract surgery. Routine preoperative biliary drainage has been suggested and bilirubin level has been kept lower than 3 mg/dL before a major hepatectomy with hilar resection. However, the serum bilirubin may affected with the undrained liver lobe. The target bilirubin level less than 3 mg/dL probably unnecessary in all patients. To study the association of preoperative bilirubin level with post-operative complications and mortality. There were 51 and 30 patients in group A and B. The operative blood loss was higher in group B but there was no significant difference. The incidence of post hepatectomy liver failure was comparable in group A and B [3.92% vs. 3.33% (p = 0.898)]. There was no significant different of 30-day mortality and 1-year survival between group A and B [3.92% vs. 6.67% (p = 0.624) and 76.47 vs. 73.33 (p = 0.536)]. Multivariate analysis revealed significant factors that associated with mortality were post hepatectomy liver failure adjusted hazard ratio = 93.70 (p < 0.001). The surgical outcome in patients who have preoperative total bilirubin level between 3 and 10 mg/dL are non-inferior to bilirubin less than 3 mg/dL. Post hepatectomy liver failure is the independent factor that associated with postoperative mortality which relate to other factors such as future remnant liver volume or major complication.