Postoperative mortality after liver resection for perihilar cholangiocarcinoma: Development of a risk score and importance of biliary drainage of the future liver remnant Journal Article


Authors: Wiggers, J. K.; Koerkamp, B. G.; Cieslak, K. P.; Doussot, A.; van Klaveren, D.; Allen, P. J.; Besselink, M. G.; Busch, O. R.; D'Angelica, M. I.; DeMatteo, R. P.; Gouma, D. J.; Kingham, T. P.; van Gulik, T. M.; Jarnagin, W. R.
Article Title: Postoperative mortality after liver resection for perihilar cholangiocarcinoma: Development of a risk score and importance of biliary drainage of the future liver remnant
Abstract: 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%. © 2016 American College of Surgeons
Journal Title: Journal of the American College of Surgeons
Volume: 223
Issue: 2
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2016-01-01
Start Page: 321
End Page: 331.e1
Language: English
DOI: 10.1016/j.jamcollsurg.2016.03.035
PROVIDER: scopus
PMCID: PMC4961586
PUBMED: 27063572
DOI/URL:
Notes: Conference Paper -- Export Date: 1 November 2016 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    627 DeMatteo
  2. Peter Allen
    482 Allen
  3. William R Jarnagin
    654 Jarnagin
  4. T Peter Kingham
    343 Kingham
  5. Alexandre Florent Doussot
    15 Doussot