Impact of preoperative biliary drainage on postoperative outcomes in patients who undergo major hepatectomy after portal vein embolization for perihilar cholangiocarcinoma

Purpose: The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC). Methods: A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (n = 111) that received PVE. Results: Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9-8.4; p < 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6-7.4; p = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6-12.7; p = 0.005). Conclusion: PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.