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Purpose <p>The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC).</p> Methods <p>A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (<i>n</i> = 111) that received PVE.</p> Results <p>Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9–8.4; <i>p</i> &lt; 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6–7.4; <i>p</i> = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6–12.7; <i>p</i> = 0.005).</p> Conclusion <p>PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.</p>

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Impact of preoperative biliary drainage on postoperative outcomes in patients who undergo major hepatectomy after portal vein embolization for perihilar cholangiocarcinoma

  • 期刊论文

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  • 发表日期：

    2025年7月8日

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  • Noriyuki Kitagawa,
  • Akira Shimizu,
  • Koji Kubota,
  • Tsuyoshi Notake,
  • Takahiro Yoshizawa,
  • Kiyotaka Hosoda,
  • Hikaru Hayashi,
  • Shigeki Hayashi,
  • Yuji Soejima

摘要

Purpose

The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC).

Methods

A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (n = 111) that received PVE.

Results

Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9–8.4; p < 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6–7.4; p = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6–12.7; p = 0.005).

Conclusion

PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.