Risk factors for early bilirubinemia after major hepatectomy for perihilar cholangiocarcinoma with portal vein embolization.

Objective: Major hepatectomy for perihilar cholangiocarcinoma has considerable risk of hepatic insufficiency even with preoperative portal vein embolization (PVE). Postoperative bilirubinemia is a great concern for hepatic surgeons.

Methods: Between 1998 and 2004, 120 patients with hilar bile duct cancer (n = 72) and intrahepatic cholangiocarcinoma (n = 48) underwent major hepatectomies with extrahepatic biliary resection. Of these, 63 patients underwent preoperative PVE to increase the future remnant liver (FRL) volume. Risk factors for early bilirubinemia after hepatectomy (> or = 2.5 mg on day 1) were evaluated using univariate and multivariate analyses.

Results: The median FRL volumes before surgery in patients with and without PVE were 46% and 70%, respectively. The serum total bilirubin (TB) value on day 1 after hepatectomy was higher in patients with PVE than in patients without PVE (2.9 mg/dL vs 1.9 mg/dL, p < 0.0001). However, the significant risk factors for higher bilirubinemia on day 1 were preoperative TB value > or = 1.0 mg/ dL (p = 0.01), blood loss > or = 1.8L (p = 0.01), and blood transfusion (p = 0.03). Two patients developed postoperative hepatic failure and one patient died of surgery from septic complication.

Conclusions: Major hepatectomies for perihilar cholangiocarcinoma were performed with acceptable safety using preoperative PVE. Postoperative early bilirubinemia was not associated with the FRL volume in this setting.