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Preoperative Biliary Drainage Is Associated with Increased Complications After Liver Resection for Proximal Cholangiocarcinoma

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Preoperative biliary drainage (PBD) prior to liver resection for hilar and intrahepatic cholangiocarcinoma (CCA) is common. While PBD for those with distal obstructions has been studied extensively and is associated with increased infectious complications, the impact of PBD among patients undergoing hepatectomy for non-disseminated proximal CCA has yet to be clearly elucidated.

Methods

Patients undergoing liver resection between 2014 and 2016 for non-disseminated hilar and intrahepatic CCA were analyzed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Associations between PBD (percutaneous or endoscopic) and 30-day outcomes were evaluated.

Results

There were 905 liver resections performed, with 186 (20.6%) for hilar CCA and 719 (79.4%) for intrahepatic CCA. Of those, 251/897 (28.0%) patients underwent PBD. Independent preoperative predictors of PBD were hilar CCA, major hepatectomy, open surgery, lower BMI, and higher preoperative bilirubin. Adjusting for preoperative variables, extent of resection, and bilirubin, PBD was independently associated with increased wound infection (OR 2.93), organ space infection (OR 3.63), sepsis (OR 3.17), renal insufficiency (OR 4.25), transfusion (OR 2.40), bile leak (OR 3.23), invasive intervention (OR 2.72), liver failure (OR 3.20), readmission (OR 3.01), reoperation (OR 2.32), and mortality (OR 4.24, all p < 0.05).

Conclusions

Among patients undergoing hepatectomy for proximal CCA, PBD is associated with increased postoperative complications. These data suggest that avoidance of routine preoperative biliary drainage may decrease short-term complications.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh Medical Center, 3459 Fifth Avenue, Pittsburgh, PA, 15213-2582, USA

    Rajesh Ramanathan, Samer Tohme & Allan Tsung

  2. Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Jeffrey Borrebach

Authors
  1. Rajesh Ramanathan
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  2. Jeffrey Borrebach
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  3. Samer Tohme
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  4. Allan Tsung
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Contributions

RR contributed to the conception, data acquisition, analysis, interpretation, drafting, and revision. JB contributed to the statistical analysis and interpretation. ST contributed to the critical review and revision. AT contributed to the conception, interpretation, drafting, and revision.

Corresponding author

Correspondence to Allan Tsung.

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The authors declare that they have no conflict of interest.

Additional information

Previous communication

Mini-oral presentation at the Americas Hepato-Pancreato-Biliary Association 2018 Annual Meeting in Miami, FL, on March 9, 2018

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Ramanathan, R., Borrebach, J., Tohme, S. et al. Preoperative Biliary Drainage Is Associated with Increased Complications After Liver Resection for Proximal Cholangiocarcinoma. J Gastrointest Surg 22, 1950–1957 (2018). https://doi.org/10.1007/s11605-018-3861-3

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  • DOI: https://doi.org/10.1007/s11605-018-3861-3

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