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Safe and permissible limits of hepatectomy in obstructive jaundice patients
Tetsuya Takahashi1, Shinji Togo, Kuniya Tanaka
1Second Department of Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004 Yokohama, Japan. ex7t-tkhs@asahi-net.or.jp
Insights
This study determined safe limits for liver resection (hepatectomy) in patients with obstructive jaundice, finding preoperative portal embolization (PE) can increase these safe limits.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Obstructive jaundice presents challenges for safe hepatectomy.
- Preoperative portal embolization (PE) is a technique to potentially increase resection limits.
Purpose of the Study:
- To examine safe and permissible limits of hepatectomy in patients with obstructive jaundice.
- To evaluate the usefulness of PE in increasing safe hepatectomy limits.
Main Methods:
- Analysis of 416 hepatectomy patients over 9 years, categorized by liver function.
- Hepatectomy performed after reducing total bilirubin below 3 mg/dl via preoperative biliary drainage.
- Investigation of factors influencing post-hepatectomy total bilirubin levels, including PE in 18 patients.
Main Results:
- Maximum post-hepatectomy total bilirubin correlated significantly with percent of liver resected.
- Safe hepatectomy limit was 48.7% and permissible limit was 71.6% in obstructive jaundice patients.
- PE reduced maximum total bilirubin and increased the safe hepatectomy limit from 48.7% to 67.4%.
Conclusions:
- Established safe (48.7%) and permissible (71.6%) hepatectomy limits for obstructive jaundice patients.
- Preoperative portal embolization significantly improves safety margins for hepatectomy in this cohort.
Abstract:
The safe and permissible limits of hepatectomy in obstructive jaundice patients and the usefulness of preoperative portal embolization (PE) for increasing the limit for safe hepatectomy were examined. We classified 416 patients with hepatectomy performed over 9 years under the following headings: normal liver function (n = 242); chronic hepatitis (n = 71); liver cirrhosis (n = 64); and liver after relief of obstructive jaundice (n = 39). Hepatectomy was done after the total bilirubin level was reduced below 3 mg/dl by preoperative biliary drainage. Factors influencing the maximum total bilirubin level measured within 2 weeks after hepatectomy were investigated, and this level was taken to reflect the degree of surgical stress. PE was carried out in 18 patients with obstructive jaundice. The maximum total bilirubin, expressed as a logarithm, was significantly correlated with the percent of liver resected in all groups. Hepatectomy followed by a maximum total bilirubin of less than 8.5 mg/dl was accepted as safe, and hepatectomy followed by a bilirubin level of 14.4 mg/dl was deemed the maximum permissible resection. On the basis of these results, the safe and permissible limits of hepatectomy in patients with obstructive jaundice were 48.7% and 71.6%, respectively. PE decreased the maximum total bilirubin from 8.5 mg/dl to 3.9 mg/dl when 48.7% of the liver (a safe proportion in all cases) was resected; PE increased the safe limit of hepatectomy from 48.7% to 67.4% when a maximum posthepatectomy total bilirubin level of 8.5 mg/dl was accepted as safe.
