RETROSPECTIVE STUDY ON SAFETY OF MAJOR HEPATECTOMY IN HILAR CHOLANGIOCARCINOMA COMPLICATED WITH HEAVILY OBSTRUCTIVE JAUNDICE

Objective To study safety of major hepatectomy in hilar cholangiocarcinoma complicated with heavily obstructive jaundice.Methods Laboratory examination results postoperative complications,and dischanrging status in consecutive 21 heavily obstructive jaundiced patients who underwent major hepatectomy since 2000 up to now were analyzed retrospectively.The mean serum total bilirubin level was 341.05 μmol/L(ranged from 191.3 μmol/L to 641.6 μmol/L).Except concomitant biliary stones being found in 1 patient,all 21 cases suffered from hilar cholangiocarcinoma.No preoperative biliary drainage wad given.The hepatic resection styles included left hepatectomy(n=14),2 of which received proper hepatic artery resection without reconstruction and 1 received portal vein reconstruction(n=1),left hepatectomy plus left caudate lobectomy(n=4),right hepatectomy(n=1),extend right hepatectomy(n=1),left hepatectomy plus left caudate lobectomy(n=4),right hepatectomy(n=1),extend right hepatectomy(n=1),extend right hepatectomy(n=1),right trisegmentectomy plus total caudated lobectomy and partial portal vein resection(n=1).Blood loss was between 400 ml to plus total caudate lobectomy and partial portal vein resection(n=1).Blood loss was between 400 ml to 2 000 ml.Results The curative and 30 d mortality rates were 95.2%(20/21) and 4.8%(1/21) respectively,which overall in-hospital morbidity was 90.5%(19/21).Postoperative complications included acute liver failure(4.8%),bile leakage(28.6%).abdominal infection(19.0%),wound problems(9.5%),cardiac failure(9.5%),and pleural effusion(4.8%).6 patients(28.6%) were discharged with temporary abdominal drainage.Conclusions Patients suffered from heavily obstructive jaundice could still tolerage major hepatic resection well if they had good general conditions and no serous concomitant disease.The mortality rate was acceptable,While postoperative morbidity being very high.