Analysis of risk factors for postoperative complications of hepatic hilar cholangiocarcinoma after extensive hepatectomy / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To analyze the relationship between clinical characteristics and postoperative complications in patients with hilar cholangiocarcinoma(HCCA) who underwent major liver resection(MLR).METHODS: Clinical characteristics and postoperative complications of 335 patients with HCCA who underwent MLR from January 2010 to October 2017 were retrospectively analyzed.According to the severity of complications,the patients were divided into two groupslow clavien-dindo group(LCD)and high clavien-dindo group(HCD).RESULTS: There were 219 patients in LCD group and 116 patients in HCD group.Elevated INR,Bismuth Ⅲa/Ⅳ type and the right liver/expanding right/right trilobites resection were high risk factors of postoperative serious complications.The incidence of severe postoperative complications in the group with preoperative biliary drainage was 34.18%(67/196),which was not statistically significant different from that in the group without preoperative biliary drainage [35.25%(49/139),P=0.8396].The dose-response curve and Logistic regression indicated that there was a statistical difference in postoperative complication risk between patients with total bilirubin(TB)<140 mol/L and patients with TB≥ 140 mol/L(OR=1.917,95% CI 1.147～3.203,P=0.0130).After statistical correction,the statistical correlation remained,among which,the preoperative biliary drainage rate was 59.2%(151/255) in the group with TB<140 mol/L,and 56.3%(45/80)in the group with TB≥ 140 mol/L.CONCLUSION: In patients with HCCA combined with MLR,patients with TB ≥ 140 mol/L should be routinely treated with preoperative biliary drainage.Especially for the right liver resection,preoperative high INR patients,more attention should be paid to.METHODS: of preoperative biliary drainage have no significant effect on the overall postoperative complications and can be flexibly selected according to the needs of the disease.