title: Major hepatectomies for perihilar cholangiocarcinoma: Predictors for clinically relevant postoperative complications using the International Study Group of Liver Surgery definitions.
abstract: OBJECTIVE
  Major hepatectomies are widely used in curative-intent surgery for perihilar cholangiocarcinoma, but morbidity rates are high. The aim of the study is to explore potential predictors for clinically relevant complications after major hepatectomies for perihilar cholangiocarcinoma.
  
  
  METHODS
  Seventy patients were included. Univariate and multivariate analyses were performed for risk factors of morbidities using the International Study Group of Liver Surgery definitions.
  
  
  RESULTS
  Severe morbidity rate was 36.5%. Clinically relevant posthepatectomy liver failure, bile leak, and hemorrhage rates were 24%, 22%, and 8.5%, respectively. A neutrophil-to-lymphocyte ratio > 3.3 is an independent prognostic factor for severe complications (hazard ratio = 1.258; 95% confidence interval 1.008-1.570; p = 0.042) while the number of blood units > 3 is an independent prognostic factor for clinically relevant liver failure (hazard ratio = 1.254; 95% confidence interval 1.082-1.452; p = 0.003). Biliary drainage and portal vein resection were not statistically correlated with any postoperative complication (p ≥ 0.101). Significantly higher bilirubinemia levels were observed in patients with postoperative hemorrhage (p = 0.023).
  
  
  CONCLUSIONS
  Clinically relevant morbidity rates after major hepatectomies for perihilar cholangiocarcinoma are high. Liver failure represents the main complication and is correlated with the number of transfused blood units. A patient with increased bilirubinemia appears to have a high risk for postoperative hemorrhage. Biliary drainage and portal vein resection does not appear to have a detrimental effect on morbidities. Neutrophil-to-lymphocyte ratio is a novel independent predictor for severe morbidity after major hepatectomies for perihilar cholangiocarcinoma and may contribute to better and informed decision-making.
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania.
authors.forename: Traian
authors.initials: T
authors.lastname: Dumitrascu
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania.
authors.forename: Vladislav
authors.initials: V
authors.lastname: Brasoveanu
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania.
authors.forename: Cezar
authors.initials: C
authors.lastname: Stroescu
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania.
authors.forename: Mihnea
authors.initials: M
authors.lastname: Ionescu
authors.affiliation: Center of General Surgery and Liver Transplant, Fundeni Clinical Institute, Fundeni Street, Bucharest, Romania. Electronic address: irinel.popescu220@gmail.com.
authors.forename: Irinel
authors.initials: I
authors.lastname: Popescu
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D001646:Bile; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001803:Blood Transfusion; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D006932:Hyperbilirubinemia / Q000150:complications; D018285:Klatskin Tumor / Q000601:surgery*; D007958:Leukocyte Count; D017093:Liver Failure / Q000209:etiology; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D019106:Postoperative Hemorrhage / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
keywords: complications; major liver resection; perihilar cholangiocarcinoma