title: Postoperative Outcome after Major Liver Resection in Jaundiced Patients with Proximal Bile Duct Cancer without Preoperative Biliary Drainage.
abstract: OBJECTIVE
  The need for routine use of preoperative biliary drainage (PBD) before major liver resection in jaundiced patients has recently been questioned. Our aim was to present our experience of patients with proximal bile duct cancer who undergo major liver resection without PBD and compare these results with patients without biliary obstruction who underwent major liver resection.
  
  
  METHODS
  Eighty six consecutive jaundiced patients underwent major liver resection without PBD. The postoperative outcome was compared to the control group, which was the same size and matched.
  
  
  METHODS
  A case-comparison study.
  
  
  RESULTS
  Fifty nine jaundiced patients (69%) and 22 non-jaundiced patients (25%) received blood transfusion (p = 0.04). Fifty-three patients (62%) in the jaundiced group and 17 (19%) in the non-jaundiced patients experienced postoperative complications (p = 0.003). A statistically significant difference could not be detected for mortality (6 vs. 2%) and transient liver failure (10 vs. 3%). Those patients who underwent extended right hemihepatectomy (with future liver remnant <50%) express high morbidity (55 vs. 24%; p = 0.04) and mortality (23 vs. 8%; p = 0.001) compared to the non-jaundiced patients.
  
  
  CONCLUSIONS
  Major liver resection without PBD leaving a liver remnant of more than 50% is safe in jaundiced patients. However, transfusion requirement and morbidity are higher in jaundiced patients than in non-jaundiced patients.
authors.affiliation: Gastroenterology Surgical Centre, Mansoura University, Mansoura, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel Wahab
authors.forename: Ehab
authors.initials: E
authors.lastname: El Hanafy
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.forename: Ehab
authors.initials: E
authors.lastname: Atif
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sultan
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D001650:Bile Duct Neoplasms / Q000150:complications / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D001803:Blood Transfusion; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D016022:Case-Control Studies; D018281:Cholangiocarcinoma / Q000150:complications / Q000601:surgery*; D004322:Drainage; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery; D017093:Liver Failure / Q000209:etiology; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D013530:Surgical Wound Infection / Q000209:etiology