Risk factors for a high Comprehensive Complication Index score after major hepatectomy for biliary cancer: a study of 229 patients at a single institution.
The Comprehensive Complication Index (CCI) is a new tool to evaluate the postoperative condition by calculating the sum of all complications weighted by their severity. The aim of this study was to identify independent risk factors for a high CCI score (≥40) in 229 patients after major hepatectomies with biliary reconstruction for biliary cancers.



The CCI was calculated online via www.assessurgery.com. Independent risk factors were identified by multivariable analysis.



57 (25%) patients were classified as having CCI ≥ 40. On multivariable analysis, volume of intraoperative blood loss (≥2.5 L) (p = 0.004) and combined pancreatoduodenectomy (PD) (p = 0.006) were independent risk factors for CCI ≥ 40. A high level of maximum serum total bilirubin was identified as independent risk factors for a high volume of intraoperative blood loss. Liver failure (p = 0.046) was more frequent in patients with combined PD than in those without.



Patients who undergo preoperative external biliary drainage for severe jaundice might have impaired production of coagulation factors. When blood loss during liver transection becomes difficult to control, surgeons should consider various strategies, such as second-stage biliary or pancreatic reconstruction. In patients planned to undergo major hepatectomy with combined PD, preoperative portal vein embolization is mandatory to prevent postoperative liver failure.
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. Electronic address: y.nakanishi@mac.com.
Yoshitsugu
Y
Nakanishi
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takahiro
T
Tsuchikawa
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Keisuke
K
Okamura
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Toru
T
Nakamura
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Eiji
E
Tamoto
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takehiro
T
Noji
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Toshimichi
T
Asano
Department of Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan.
Toraji
T
Amano
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Toshiaki
T
Shichinohe
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Satoshi
S
Hirano
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D016063:Blood Loss, Surgical; D003661:Decision Support Techniques; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007564:Japan; D017093:Liver Failure / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D001663:Bilirubin