Preoperative Cholangitis and Future Liver Remnant Volume Determine the Risk of Liver Failure in Patients Undergoing Resection for Hilar Cholangiocarcinoma

详细信息    查看全文

• 作者：Dario Ribero ; MD^a ; ^b ; Giuseppe Zimmitti ; MD^a ; ^c ; Thomas A. Aloia ; MD ; FACS^d ; Junichi Shindoh ; MD^d ; Fabio Forchino ; MD^a ; Marco Amisano ; MD^a ; Guillaume Passot ; MD^d ; Alessandro Ferrero ; MD^a ; Jean-Nicolas Vauthey ; MD ; FACS^d ; ^{jvauthey@mdanderson.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：FLR ; future liver remnant ; HCCA ; hilar cholangiocarcinoma ; OR ; odds ratio ; PVE ; portal vein embolization
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：223
• 期：1
• 页码：87-97
• 全文大小：318 K

文摘

The highest mortality rates after liver surgery are reported in patients who undergo resection for hilar cholangiocarcinoma (HCCA). In these patients, postoperative death usually follows the development of hepatic insufficiency. We sought to determine the factors associated with postoperative hepatic insufficiency and death due to liver failure in patients undergoing hepatectomy for HCCA.

Study Design

This study included all consecutive patients who underwent hepatectomy with curative intent for HCCA at 2 centers, from 1996 through 2013. Preoperative clinical and operative data were analyzed to identify independent determinants of hepatic insufficiency and liver failure-related death.

Results

The study included 133 patients with right or left major (n = 67) or extended (n = 66) hepatectomy. Preoperative biliary drainage was performed in 98 patients and was complicated by cholangitis in 40 cases. In all these patients, cholangitis was controlled before surgery. Major (Dindo III to IV) postoperative complications occurred in 73 patients (55%), with 29 suffering from hepatic insufficiency. Fifteen patients (11%) died within 90 days after surgery, 10 of them from liver failure. On multivariate analysis, predictors of postoperative hepatic insufficiency (all p < 0.05) were preoperative cholangitis (odds ratio [OR] 3.2), future liver remnant (FLR) volume < 30% (OR 3.5), preoperative total bilirubin level >3 mg/dL (OR 4), and albumin level < 3.5 mg/dL (OR 3.3). Only preoperative cholangitis (OR 7.5, p = 0.016) and FLR volume < 30% (OR 7.2, p = 0.019) predicted postoperative liver failure-related death.

Conclusions

Preoperative cholangitis and insufficient FLR volume are major determinants of hepatic insufficiency and postoperative liver failure-related death. Given the association between biliary drainage and cholangitis, the preoperative approach to patients with HCCA should be optimized to minimize the risk of cholangitis.