Dynamic Change of Total Bilirubin after Portal Vein Embolization is Predictive of Major Complications and Posthepatectomy Mortality in Patients with Hilar Cholangiocarcinoma

This study aims to evaluate the role of dynamic change in total bilirubin after portal vein embolization (PVE) in predicting major complications and 30-day mortality in patients with hilar cholangiocarcinoma (HCCA).

Retrospective analysis of prospectively maintained data of 64 HCCA patients who underwent PVE before hepatectomy in our institution was used. Total bilirubin and other parameters were measured daily in peri-PVE period. The difference between them and the baseline value from days 0–5 to day −1 (∆D₁) and days 5–14 to day −1 (∆D₂) were calculated. The relationship between ∆D₁ and ∆D₂ of total bilirubin and major complications as well as 30-day mortality was analyzed.

Out of 64 patients, 10 developed major complications (15.6 %) and 6 patients (9.3 %) had died within 30 days after surgery. The ∆D₂ of total bilirubin after PVE was most significantly associated with major complications (P < 0.001) and 30-day mortality (P = 0.002). In addition, it was found to be an independent predictor of major complications after PVE (odds ratio (OR) = 1.050; 95 % CI 1.017–1.084). ASA >3 (OR = 12.048; 95 % CI 1.019–143.321), ∆D₂ of total bilirubin (OR = 1.058; 95 % CI 1.007–1.112), and ∆D₂ of prealbumin (OR = 0.975; 95 % CI 0.952–0.999) were associated with higher risk of 30-day mortality after PVE. Receiver operating characteristic curves showed that ∆D₂ of total bilirubin were better predictors than ∆D₁ for major complications (AUC (∆D₂) 0.817; P = 0.002 vs. AUC (∆D₁) 0.769; P = 0.007) and 30-day mortality (ACU(∆D₂) 0.868; P = 0.003 vs. AUC(∆D₁) 0.721;P = 0.076).

Patients with increased total bilirubin in 5–14 days after PVE may indicate a higher risk of major complications and 30-day mortality if the major hepatectomy were performed.