title: Risk factors for early bilirubinemia after major hepatectomy for perihilar cholangiocarcinoma with portal vein embolization.
abstract: OBJECTIVE
  Major hepatectomy for perihilar cholangiocarcinoma has considerable risk of hepatic insufficiency even with preoperative portal vein embolization (PVE). Postoperative bilirubinemia is a great concern for hepatic surgeons.
  
  
  METHODS
  Between 1998 and 2004, 120 patients with hilar bile duct cancer (n = 72) and intrahepatic cholangiocarcinoma (n = 48) underwent major hepatectomies with extrahepatic biliary resection. Of these, 63 patients underwent preoperative PVE to increase the future remnant liver (FRL) volume. Risk factors for early bilirubinemia after hepatectomy (> or = 2.5 mg on day 1) were evaluated using univariate and multivariate analyses.
  
  
  RESULTS
  The median FRL volumes before surgery in patients with and without PVE were 46% and 70%, respectively. The serum total bilirubin (TB) value on day 1 after hepatectomy was higher in patients with PVE than in patients without PVE (2.9 mg/dL vs 1.9 mg/dL, p < 0.0001). However, the significant risk factors for higher bilirubinemia on day 1 were preoperative TB value > or = 1.0 mg/ dL (p = 0.01), blood loss > or = 1.8L (p = 0.01), and blood transfusion (p = 0.03). Two patients developed postoperative hepatic failure and one patient died of surgery from septic complication.
  
  
  CONCLUSIONS
  Major hepatectomies for perihilar cholangiocarcinoma were performed with acceptable safety using preoperative PVE. Postoperative early bilirubinemia was not associated with the FRL volume in this setting.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. yosakamo@ncc.go.jp
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shimada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nara
authors.forename: Minoru
authors.initials: M
authors.lastname: Esaki
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kajiwara
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Arai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sano
authors.forename: Junji
authors.initials: J
authors.lastname: Yamamoto
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kosuge
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000097:blood / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D006932:Hyperbilirubinemia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome