title: External biliary drainage following major liver resection for perihilar cholangiocarcinoma: impact on development of liver failure and biliary leakage.
abstract: BACKGROUND
  Preoperative biliary drainage is considered essential in perihilar cholangiocarcinoma (PHC) requiring major hepatectomy with biliary-enteric reconstruction. However, evidence for postoperative biliary drainage as to protect the anastomosis is currently lacking. This study investigated the impact of postoperative external biliary drainage on the development of post-hepatectomy biliary leakage and liver failure (PHLF).
  
  
  METHODS
  All patients who underwent major liver resection for suspected PHC between 2000 and 2015 were retrospectively analyzed. Biliary leakage and PHLF was defined as grade B or higher according to the International Study Group of Liver Surgery (ISGLS) criteria.
  
  
  RESULTS
  Eighty-nine out of 125 (71%) patients had postoperative external biliary drainage. PHLF was more prevalent in the drain group (29% versus 6%; P = 0.004). There was no difference in the incidence of biliary leakage (32% versus 36%). On multivariable analysis, postoperative external biliary drainage was identified as an independent risk factor for PHLF (Odds-ratio 10.3, 95% confidence interval 2.1-50.4; P = 0.004).
  
  
  CONCLUSIONS
  External biliary drainage following major hepatectomy for PHC was associated with an increased incidence of PHLF. It is therefore not recommended to routinely use postoperative external biliary drainage, especially as there is no evidence that this decreases the risk of biliary anastomotic leakage.
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. Electronic address: p.b.olthof@amc.nl.
authors.forename: Pim B
authors.initials: PB
authors.lastname: Olthof
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Robert J S
authors.initials: RJ
authors.lastname: Coelen
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jimme K
authors.initials: JK
authors.lastname: Wiggers
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marc G H
authors.initials: MG
authors.lastname: Besselink
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Olivier R C
authors.initials: OR
authors.lastname: Busch
authors.affiliation: Department of Surgery, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis / Q000209:etiology*; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D004322:Drainage / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D018285:Klatskin Tumor / Q000473:pathology / Q000601:surgery*; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome