Zhao Haoyu, Li Baifeng, Li Xiaohang, Lv Xiangning, Guo Tingwei, Dai Zongbo, Zhang Chengshuo, Zhang Jialin
Department of Hepatobiliary Surgery, The First Hospital of China Medical University, Shenyang, China.
Department of Radiology, The First Hospital of China Medical University, Shenyang, China.
Front Oncol. 2024 Apr 19;14:1375648. doi: 10.3389/fonc.2024.1375648. eCollection 2024.
For patients with hilar cholangiocarcinoma (HC) undergoing hemi-hepatectomy, there are controversies regarding the requirement of, indications for, and timing of preoperative biliary drainage (PBD). Dynamic three-dimensional volume reconstruction could effectively evaluate the regeneration of liver after surgery, which may provide assistance for exploring indications for PBD and optimal preoperative bilirubin value. The purpose of this study was to explore the indications for PBD and the optimal preoperative bilirubin value to improve prognosis for HC patients undergoing hemi-hepatectomy.
We retrospectively analyzed the data of HC patients who underwent hemi-hepatectomy in the First Affiliated Hospital of China Medical University from 2012 to 2023. The liver regeneration rate was calculated using three-dimensional volume reconstruction. We analyzed the factors affecting the liver regeneration rate and occurrence of postoperative liver insufficiency.
This study involved 83 patients with HC, which were divided into PBD group (n=36) and non-PBD group (n=47). The preoperative bilirubin level may be an independent risk factor affecting the liver regeneration rate (=0.014) and postoperative liver insufficiency (=0.016, odds ratio=1.016, β=0.016, 95% CI=1.003-1.029). For patients whose initial bilirubin level was >200 μmol/L (n=45), PBD resulted in better liver regeneration in the early stage (=0.006) and reduced the incidence of postoperative liver insufficiency [=0.012, odds ratio=0.144, 95% confidence interval (CI)=0.031-0.657]. The cut-off value of bilirubin was 103.15 μmol/L based on the liver regeneration rate. Patients with a preoperative bilirubin level of ≤103.15 μmol/L shown a better liver regeneration (<0.01) and lower incidence of postoperative hepatic insufficiency (=0.011, odds ratio=0.067, 95% CI=0.008-0.537).
For HC patients undergoing hemi-hepatectomy whose initial bilirubin level is >200 μmol/L, PBD may result in better liver regeneration and reduce the incidence of postoperative liver insufficiency. Preoperative bilirubin levels ≤103.15 μmol/L maybe recommended for leading to a better liver regeneration and lower incidence of postoperative hepatic insufficiency.
对于接受半肝切除术的肝门部胆管癌（HC）患者，术前胆道引流（PBD）的必要性、指征及时机存在争议。动态三维容积重建可有效评估术后肝脏再生情况，这可能有助于探索PBD的指征及最佳术前胆红素值。本研究旨在探讨PBD的指征及最佳术前胆红素值，以改善接受半肝切除术的HC患者的预后。
我们回顾性分析了2012年至2023年在中国医科大学附属第一医院接受半肝切除术的HC患者的数据。使用三维容积重建计算肝脏再生率。我们分析了影响肝脏再生率及术后肝功能不全发生的因素。
本研究纳入83例HC患者，分为PBD组（n = 36）和非PBD组（n = 47）。术前胆红素水平可能是影响肝脏再生率（= 0.014）及术后肝功能不全（= 0.016，比值比 = 1.016，β = 0.016，95%可信区间 = 1.003 - 1.029）的独立危险因素。对于初始胆红素水平>200 μmol/L的患者（n = 45），PBD可使早期肝脏再生更好（= 0.006），并降低术后肝功能不全的发生率[= 0.012，比值比 = 0.144, 95%置信区间（CI）= 0.031 - 0.657]。基于肝脏再生率，胆红素的截断值为103.15 μmol/L。术前胆红素水平≤103.15 μmol/L的患者肝脏再生更好（<0.01），术后肝衰竭发生率更低（= 0.011，比值比 = 0.067，95% CI = 0.008 - 0.537）。
对于接受半肝切除术且初始胆红素水平>200 μmol/L的HC患者，PBD可能导致更好的肝脏再生并降低术后肝功能不全的发生率。建议术前胆红素水平≤103.15 μmol/L，以实现更好的肝脏再生并降低术后肝衰竭的发生率。
