Preoperative Liver Function as a Predictor of Postoperative Liver Failure in Perihilar Cholangiocarcinoma

Operative mortality following surgical intervention for perihilar cholangiocarcinoma (PHCC) is attributable to clinically relevant liver failure (CRLF). Nonetheless, the risk factors for CRLF in patients undergoing preoperative portal vein embolization (PVE) remain undetermined. This study aimed to investigate the risk factors for CRLF following major hepatectomy with PVE in patients with PHCC.

We retrospectively assessed patients with PHCC. Post PVE, a value for rate of plasma disappearance of indocyanine green×residual liver volume (%) (ICGKF) ≥0.05 warranted curative resection.

In total, 346 patients were reviewed. CRLF developed in 27.5% of the patients. Operative time >660 min, blood loss >1,900 ml, and procedures other than left hepatectomy were independent risk factors for CRLF. Subsequently, 167 patients undergoing PVE were included in the analysis. Pre-PVE ICGKF <0.05, long operative time, and high intraoperative bleeding were independent risk factors for CRLF. The mortality rate for patients with all three risk factors was 25%. The incidence of CRLF after hepatectomy with extended bile duct resection for perihilar cholangiocarcinoma was 27.5%.

Prolonged surgery, and high blood loss are associated with an elevated mortality rate following PHCC surgery, particularly when accompanied by low pre-PVE ICGKF.