Role of biliary drainage before major hepatectomy for hilar cholangiocarcinoma:a clinical study

Abstract

Objective To evaluate the role of biliary drainage before major hepatectomy for hilar cholangiocarcinoma(HCCA) accompanied by obstructive jaundice.Methods A retrospective analysis of clinical and imaging data was conducted among cases of HCCA accompanied by obstructive jaundice and undergone major hepatectomy in General Hospital of PLA between Jun 2005 and Apr 2011.Liver volumetry was conducted individually and the standardized remnant liver volume ratio(SRLVR) was calculated accorcling to a formula: remnant liver volume(RLV)/ standard total liver volume(SLV).According to whether biliary drainage was conducted or not,all cases were divided into two groups and short-term outcomes between the two groups were compared.Results Altogether,117 cases of HCCA accompanied by obstructive jaundice underwent major hepatectomy and liver volumetry.The mean SRLVR was 52.3%,the postoperative mortality was 6.8%,the overall postoperative complication rate was 41.9%,the incidence of liver failure was 14.5%,the infectious complication rate was 9.7%,and the mean duration of postoperative hospital stay was 17.8 days(5-64 days).The multivariate analysis showed that SRLVR≤40%(OR:71.63,95%CI 8.07-635.96,P0.001) and preoperative bilirubin186.7 μmol/L(OR:17.29,95%CI 1.97-151.92,P=0.01) were independent risk factors for postoperative liver failure individually.In cases with SRLVR40%,the infectious complication rate in biliary drainage subgroup was significantly higher than that in non-drainage one,but the postoperative mortality,overall morbidity,incidence of liver failure and length of postoperative hospital stay between the two subgroups were not significantly different.In cases with SRLVR≤40%,however,the postoperative mortality,incidence of liver failure and length of postoperative stay in biliary drainage subgroup were significantly lower than in non-drainage one,but the overall postoperative morbidity and infectious complication rate between the two subgroups were not significantly different.Conclusion In cases with SRLVR≤40%,the application of PBD before liver resection for patients with HCCA accompanied by obstructive jaundice could markedly reduce postoperative mortality,incidence of liver failure and length of postoperative stay.In cases with SRLVR40%,it can evidently increase the infectious complication rate,so the selective application of PBD in this setting is preferred.