Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure. (2nd July 2020)

• Record Type: Journal Article
• Authors: Uemura, Shuichiro; Higuchi, Ryota; Yazawa, Takehisa; Izumo, Wataru; Otsubo, Takehito; Yamamoto, Masakazu
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 27:Number 9(2020)
• Page Start: 614
• Page End: 621
• Publication Date: 2020-07-02
• Subjects: jaundice -- bilirubin -- drainage -- hepatectomy -- liver failure; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.784
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: We investigated whether the daily level of total bilirubin in the bile (LTB) excreted from the future remnant liver (FRL) can predict post‐hepatectomy liver failure (PHLF) in patients with obstructive jaundice undergoing hepatectomy. Methods: Seventy‐four patients who underwent biliary drainage and collection of bile juice from the FRL before undergoing right hepatectomy or right/left trisectionectomy with bile duct resection were included. The LTB from the FRL (mg/d) was calculated as the volume of the bile (dL) per day multiplied by the density of total bilirubin in the bile (mg/dL). We compared patients' characteristics with or without PHLF, which was defined as the total serum bilirubin level remaining >10 mg/dL after postoperative day 10. Then, pre‐ and intraoperative factors related to PHLF were examined. Results: PHLF was observed in six patients. LTB was significantly lower in the PHLF group. The LTB cut‐off value for predicting PHLF, as determined using the receiver operating characteristic curve, was 56 mg/d. On multivariate analysis, LTB was found to be an independent risk factor for PHLF ( P = .01, OR 35.88). Conclusions: LTB may be a potential functional assessment in jaundiced patients before right hepatectomy and right/left trisectionectomy. Abstract : Highlight Uemura and colleagues investigated the factors associated with postoperative liver failure in jaundiced patients undergoing major hepatectomy with bile duct resection. The daily total bilirubin level in the bile excreted from the future remnant liver was an independent risk factor for postoperative liver failure, suggesting its potential for functional assessment.