title: A Clear Difference Between the Outcomes After a Major Hepatectomy With and Without an Extrahepatic Bile Duct Resection.
abstract: The procedure of a simple hepatectomy and a hepatectomy with an extrahepatic bile duct resection and subsequent choledocho-jejunostomy is largely different. However, these two procedures are sometimes included in the same category. There are no studies comparing postoperative course and liver regeneration rate after a major hepatectomy with and without an extrahepatic bile duct resection.
  
  
  
  We retrospectively reviewed medical records of 245 patients who underwent a right hepatectomy (RH, n = 55) or RH with an extrahepatic bile duct resection (RHEBR, n = 190). Postoperative complications, including incidence of posthepatectomy liver failure (PHLF) and hepatic regeneration rates after surgery, were evaluated.
  
  
  
  The incidence of PHLF was considerably higher in the RHEBR group than in the RH group (39.5 vs. 16.4 %, p = 0.001). The percentage of newly regenerated liver volume after the hepatectomies on postoperative days 6-8 was significantly lower in the RHEBR group than in the RH group (14.0 % in the RH; 7.9 % in the RHEBR group, p < 0.001). Especially type of surgery (RHEBR) was the only independent risk factor for an impaired liver regeneration rate by univariate and multivariate analyses. Furthermore, estimated hepatic regeneration rate by stepwise linear regression analysis in the RHEBR group was 7.1 % lower (95 % confidence interval 1.8-12.3, p = 0.011) than in the RH group.
  
  
  
  These results suggest that the procedure of extrahepatic bile duct resection has a possibility of adverse impact on the postoperative outcome after major hepatectomy.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. yyoko@med.nagoya-u.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kokuryo
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.affiliation: Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000601:surgery; D017734:Bile Ducts, Extrahepatic / Q000601:surgery*; D016063:Blood Loss, Surgical; D018281:Cholangiocarcinoma / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000209:etiology; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies