Preoperative Biliary Drainage Is Associated with Increased Complications After Liver Resection for Proximal Cholangiocarcinoma

• Published in: Journal of gastrointestinal surgery 2018-11, Vol.22 (11), p.1950-1957
• Main Authors: Ramanathan, Rajesh, Borrebach, Jeffrey, Tohme, Samer, Tsung, Allan
• Format: Article
• Language: English
• Subjects: Aged; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic - surgery; Blood Transfusion - statistics & numerical data; Cholangiocarcinoma; Cholangiocarcinoma - surgery; Cholangitis; Databases, Factual; Drainage - adverse effects; Drainage - statistics & numerical data; Female; Gastroenterology; Gastrointestinal surgery; Hepatectomy; Hepatectomy - adverse effects; Hepatectomy - methods; Hepatectomy - mortality; Humans; Liver; Liver cancer; Liver Failure - epidemiology; Liver Failure - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Preoperative Care - adverse effects; Renal Insufficiency - epidemiology; Renal Insufficiency - etiology; Reoperation - statistics & numerical data; Sepsis - epidemiology; Sepsis - etiology; Surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; United States - epidemiology
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-018-3861-3

Background Preoperative biliary drainage (PBD) prior to liver resection for hilar and intrahepatic cholangiocarcinoma (CCA) is common. While PBD for those with distal obstructions has been studied extensively and is associated with increased infectious complications, the impact of PBD among patients undergoing hepatectomy for non-disseminated proximal CCA has yet to be clearly elucidated. Methods Patients undergoing liver resection between 2014 and 2016 for non-disseminated hilar and intrahepatic CCA were analyzed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Associations between PBD (percutaneous or endoscopic) and 30-day outcomes were evaluated. Results There were 905 liver resections performed, with 186 (20.6%) for hilar CCA and 719 (79.4%) for intrahepatic CCA. Of those, 251/897 (28.0%) patients underwent PBD. Independent preoperative predictors of PBD were hilar CCA, major hepatectomy, open surgery, lower BMI, and higher preoperative bilirubin. Adjusting for preoperative variables, extent of resection, and bilirubin, PBD was independently associated with increased wound infection (OR 2.93), organ space infection (OR 3.63), sepsis (OR 3.17), renal insufficiency (OR 4.25), transfusion (OR 2.40), bile leak (OR 3.23), invasive intervention (OR 2.72), liver failure (OR 3.20), readmission (OR 3.01), reoperation (OR 2.32), and mortality (OR 4.24, all p