Risk factors for acute liver failure after radical surgery combined with hemihepatectomy for hilar cholangiocarcinoma / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the high-risk factors for acute liver failure after radical surgery combined with hemihepatectomy for hilar cholangiocarcinoma (HC). MethodsA retrospective analysis was performed for the clinical data of 126 patients who were admitted to Chongqing Cancer Institute and underwent radical surgery combined with hemihepatectomy for HC from January 2000 to December 2014, including sex, age, preoperative serum levels of total bilirubin (TBil) and albumin (Alb), preservation of hepatic artery blood supply or not, application of nonselective hepatic vascular occlusion or not, intraoperative blood loss volume, and time of operation. The chi-square test was used for comparison of categorical data between groups, and multivariate logistic regression analysis was performed to determine independent risk factors for acute liver failure after surgery. ResultsA total of 17 patients (13.49%) experienced acute liver failure, and 11 patients(873%) died. A preoperative serum TBil level of ＞200 μmol/L(OR=178,95%CI:105-304,P=0029), an intraoperative blood loss volume of ＞800 ml(OR=264,95%CI:133-395,P=0003), no preservation of hepatic artery blood supply（OR=357，95%CI：221-509，P=0002）, and application of nonselective hepatic vascular occlusion(OR=136,95%CI:079-178,P=0037) were independent risk factors for acute liver failure after surgery. ConclusionPreoperative biliary drainage, a reduced intraoperative blood loss volume, preservation of hepatic artery blood supply, and avoiding nonselective hepatic vascular occlusion have great significance in reducing acute liver failure after radical surgery combined with hemihepatectomy for HC.