Postoperative Mortality after Liver Resection for Perihilar Cholangiocarcinoma: Development of a Risk Score and Importance of Biliary Drainage of the Future Liver Remnant.

Conference Paper

BACKGROUND: Liver surgery for perihilar cholangiocarcinoma (PHC) is associated with postoperative mortality ranging from 5% to 18%. The aim of this study was to develop a preoperative risk score for postoperative mortality after liver resection for PHC, and to assess the effect of biliary drainage of the future liver remnant (FLR). STUDY DESIGN: A consecutive series of 287 patients submitted to major liver resection for presumed PHC between 1997 and 2014 at 2 Western centers was analyzed; 228 patients (79%) underwent preoperative drainage for jaundice. Future liver remnant volumes were calculated with CT volumetry and completeness of FLR drainage was assessed on imaging. Logistic regression was used to develop a mortality risk score. RESULTS: Postoperative mortality at 90 days was 14% and was independently predicted by age (odds ratio [OR] per 10 years = 2.1), preoperative cholangitis (OR = 4.1), FLR volume <30% (OR = 2.9), portal vein reconstruction (OR = 2.3), and incomplete FLR drainage in patients with FLR volume <50% (OR = 2.8). The risk score showed good discrimination (area under the curve = 0.75 after bootstrap validation) and ranking patients in tertiles identified 3 (ie low, intermediate, and high) risk subgroups with predicted mortalities of 2%, 11%, and 37%. No postoperative mortality was observed in 33 undrained patients with FLR volumes >50%, including 10 jaundiced patients (median bilirubin level 11 mg/dL). CONCLUSIONS: The mortality risk score for patients with resectable PHC can be used for patient counseling and identification of modifiable risk factors, which include FLR volume, FLR drainage status, and preoperative cholangitis. We found no evidence to support preoperative biliary drainage in patients with an FLR volume >50%.

Full Text

Duke Authors

Cited Authors

  • Wiggers, JK; Groot Koerkamp, B; Cieslak, KP; Doussot, A; van Klaveren, D; Allen, PJ; Besselink, MG; Busch, OR; D'Angelica, MI; DeMatteo, RP; Gouma, DJ; Kingham, TP; van Gulik, TM; Jarnagin, WR

Published Date

  • August 2016

Published In

Volume / Issue

  • 223 / 2

Start / End Page

  • 321 - 331.e1

PubMed ID

  • 27063572

Pubmed Central ID

  • PMC4961586

Electronic International Standard Serial Number (EISSN)

  • 1879-1190

Digital Object Identifier (DOI)

  • 10.1016/j.jamcollsurg.2016.03.035

Conference Location

  • United States