Preoperative Biliary Drainage Is Associated with Increased Complications After Liver Resection for Proximal Cholangiocarcinoma
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.
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.
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).
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.
KeywordsHilar Intrahepatic Stent Endoscopic drainage Biliary stent Stenting Liver cancer Bile leak ERCP Cholangitis Biliary obstruction Jaundice Hepatectomy Liver resection
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.
- 1.Liver and Intrahepatic Bile Duct Cancer - Cancer Stat Facts [Internet]. [cited 2018 Feb 15]. Available from: https://seer.cancer.gov/statfacts/html/livibd.html
- 2.Cherqui D, Benoist S, Malassagne B, Humeres R, Rodriguez V, Fagniez PL. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg Chic Ill 1960. 2000 Mar;135(3):302–8.Google Scholar
- 4.Lai ECH, Lau SHY, Lau WY. The current status of preoperative biliary drainage for patients who receive pancreaticoduodenectomy for periampullary carcinoma: a comprehensive review. Surg J R Coll Surg Edinb Irel. 2014 Oct;12(5):290–6.Google Scholar
- 11.Hochwald SN, Burke EC, Jarnagin WR, Fong Y, Blumgart LH. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg Chic Ill 1960 1999 Mar;134(3):261–6.Google Scholar
- 12.ACS National Surgical Quality Improvement Program [Internet]. [cited 2018 Feb 15]. Available from: https://www.facs.org/quality-programs/acs-nsqip
- 19.Saiki S, Chijiiwa K, Komura M, Yamaguchi K, Kuroki S, Tanaka M. Preoperative internal biliary drainage is superior to external biliary drainage in liver regeneration and function after hepatectomy in obstructive jaundiced rats. Ann Surg. 1999 Nov;230(5):655–62.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Figueras J, Llado L, Valls C, Serrano T, Ramos E, Fabregat J, et al. Changing strategies in diagnosis and management of hilar cholangiocarcinoma. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2000 Nov;6(6):786–94.Google Scholar
- 25.Ramanathan R, Mason T, Wolfe LG, Kaplan BJ. Predictors of Short-Term Readmission After Pancreaticoduodenectomy. J Gastrointest Surg Off J Soc Surg Aliment Tract. 2018 Feb 5Google Scholar