Preoperative biliary drainage increases XXXX after hepatectomy for proximal bile duct tumor obstruction.

@entity1 @entity1087 @entity648 @entity189 @entity166
BACKGROUND: The role of preoperative biliary drainage before liver resection in @entity1087 @entity1 remains controversial. The objective of this study is to compare the perioperative outcome of liver resection for @entity189 involving the proximal bile duct in @entity1087 @entity1 with and without preoperative biliary drainage. METHODS: Seventy-four consecutive @entity1087 @entity1 underwent hepatectomy for @entity189 involving the proximal bile duct from January 1989 to June 2006 and their data were retrospectively analyzed. Fourteen @entity1 underwent biliary drainage before portal vein embolization and were excluded from the study. Thirty @entity1 underwent biliary drainage before hepatectomy and 30 underwent liver resection without preoperative biliary drainage. All @entity1 underwent resection of the extrahepatic bile duct. RESULTS: Overall mortality and operative morbidity were similar in the two groups (3% vs. 10%, p = 0.612 and 70% vs. 63%, p = 0.583, respectively). The incidence of noninfectious complications was similar in the two groups. There was no difference in hospital stay between the two groups. @entity1 with preoperative biliary drainage had a significantly higher rate of @entity166 (40% vs. 17%, p = 0.044). At multivariate analysis, preoperative biliary drainage was the only independent risk factor for infectious complication in the postoperative course (RR = 4.411, 95%CI = 1.216-16.002, p = 0.024). Even considering @entity1 with preoperative biliary drainage in whom the @entity648 level went below 5 mg/dl, the risk of @entity166 was higher compared with @entity1 without biliary drainage (47.6% vs. 16.6%, p = 0.017). CONCLUSIONS: Overall mortality and morbidity after liver resection are not improved by preoperative biliary drainage in @entity1087 @entity1 . Prehepatectomy biliary drainage increases the incidence of @entity166 .
