Risk factors for early bilirubinemia after major hepatectomy for perihilar cholangiocarcinoma with portal vein embolization.
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.
Sakamoto
Yoshihiro
Y
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. yosakamo@ncc.go.jp
Shimada
Kazuaki
K
Nara
Satoshi
S
Esaki
Minoru
M
Kajiwara
Takahiro
T
Arai
Yasuaki
Y
Sano
Tsuyoshi
T
Yamamoto
Junji
J
Kosuge
Tomoo
T
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