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

  • Rajesh Ramanathan
  • Jeffrey Borrebach
  • Samer Tohme
  • Allan Tsung
Original Article

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.

Keywords

Hilar Intrahepatic Stent Endoscopic drainage Biliary stent Stenting Liver cancer Bile leak ERCP Cholangitis Biliary obstruction Jaundice Hepatectomy Liver resection 

Notes

Author 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.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Rajesh Ramanathan
    • 1
  • Jeffrey Borrebach
    • 2
  • Samer Tohme
    • 1
  • Allan Tsung
    • 1
  1. 1.Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Wolff Center at UPMCUniversity of Pittsburgh Medical CenterPittsburghUSA

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