title: Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage.
abstract: BACKGROUND
  The role of preoperative biliary drainage (PBD) before liver resection in the presence of obstructive jaundice remains controversial. Our patients with proximal duct carcinoma undergo noninvasive assessment followed by rapid laparotomy without PBD if the lesion is deemed resectable.
  
  
  OBJECTIVE
  Our aim was to report operative outcome of these patients and to analyze their specific features by comparison with patients without biliary obstruction who underwent major liver resection.
  
  
  METHODS
  A case-comparison study.
  
  
  METHODS
  A tertiary care university hospital in a metropolitan area.
  
  
  METHODS
  Twenty consecutive jaundiced patients underwent major liver resection without PBD. The jaundiced patients were matched with 27 nonjaundiced patients with normal underlying liver selected from a computer bank of 261 patients undergoing liver resections and identical for age, tumor size, type of liver resection, and vascular occlusion.
  
  
  METHODS
  Postoperative course including mortality, morbidity, transfusion rates, and results of liver function tests.
  
  
  RESULTS
  Seventeen jaundiced patients (85%) and 13 nonjaundiced patients (48%) received blood transfusions (P = .03). Morbidity was 50% in jaundiced and 15% in nonjaundiced patients (P = .006), mainly resulting from subphrenic collections and bile leaks occurring only in jaundiced patients. In contrast, there were no significant differences for mortality (5% vs 0%) and liver failure (5% vs 0%). Postoperative changes in liver function test results were comparable between groups.
  
  
  CONCLUSIONS
  Major liver resections without PBD are safe in most patients with obstructive jaundice. Recovery of hepatic synthetic function is identical to that of nonjaundiced patients. Transfusion requirements and incidence of postoperative complications, especially bile leaks and subphrenic collections, are higher in jaundiced patients. Whether PBD could improve these results remains to be determined.
authors.affiliation: Department of Digestive Surgery, Hôpital Henri Mondor, Université Paris XII, Créteil, France. daniel.cherqui@hmn.ap-hop-paris.fr
authors.forename: D
authors.initials: D
authors.lastname: Cherqui
authors.forename: S
authors.initials: S
authors.lastname: Benoist
authors.forename: B
authors.initials: B
authors.lastname: Malassagne
authors.forename: R
authors.initials: R
authors.lastname: Humeres
authors.forename: V
authors.initials: V
authors.lastname: Rodriguez
authors.forename: P L
authors.initials: PL
authors.lastname: Fagniez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000601:surgery*; D002779:Cholestasis / Q000601:surgery*; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome