Postoperative hyperbilirubinemia after resection of thoracic esophageal cancer

The rate of occurrence of postoperative hyperbilirubinemia (PHB) following esophagectomy for thoracic esophageal cancer was 67%, 115/171 cases, which was significantly higher than those following total gastrectomy (28%, 40/144 cases) and colectomy (12%, 7/59 cases). Among the operative procedures, right thoracotomy with extensive lymphoadenectomy had the highest rate of PHB (87%), perhaps due to the longest operation time and the largest intraoperative blood loss. Preoperative risk factors were glucose intolerance, reduced lymphocyte count, and poor nutritional state. The change in bile acid composition, as well as the elevation of alkaline phosphatase and gamma-glutamyl transpeptidase, indicated the presence of postoperative cholestasis which was relevant to total parenteral nutrition. The results suggest that the development of PHB was related to the extent of surgery and the use of parenteral nutrition.