The adverse effects of preoperative cholangitis on the outcome of portal vein embolization and subsequent major hepatectomies

BackgroundThe presence of cholangitis has been shown to impair liver regeneration capacity after major hepatectomy in a rat cholangitis model. It is unclear, however, whether the presence of cholangitis has any impact on liver generation in clinical settings.ObjectiveTo determine the effects of preoperative cholangitis on hepatic regeneration rates after preoperative portal vein embolizations (PVEs) and postoperative courses after major hepatectomies in humans.MethodsFrom 1991 to 2012, 450 patients underwent preoperative PVEs and subsequent major hepatectomies. Among them, 72 patients (16.0%) had preoperative cholangitis. The volume change of the nonembolized lobe after PVE and the postoperative outcomes after a major hepatectomy were compared between cholangitis and noncholangitis groups.ResultsThe average volume increase in the nonembolized lobe after PVE was almost identical in both the cholangitis (10.0%) and noncholangitis (9.5%) groups. The average term required to acquire institutional safety criteria, however, was longer in the cholangitis group (24.3 days) compared with the noncholangitis group (18.3 days) (P < .001). The postoperative maximum serum total bilirubin levels (5.7 mg/dL vs 8.1 mg/dL, P = .035), morbidity rate (56% vs 78%, P = .001), and postoperative hospital stay (44 days vs 53 days, P = .021) were all greater in the cholangitis group compared with the noncholangitis group. With multivariate logistic regression analyses, the presence of preoperative cholangitis was identified as one of the independent risk factors for postoperative morbidity.ConclusionThese results indicate that patients with preoperative cholangitis should be carefully managed during their perioperative periods of PVE and after major hepatectomies.