# Impact of preoperative biliary drainage on postoperative outcomes in patients who undergo major hepatectomy after portal vein embolization for perihilar cholangiocarcinoma

## TL;DR

This study examines whether preoperative biliary drainage affects liver failure after major liver surgery for perihilar cholangiocarcinoma, finding that it does not increase risk if proper infection prevention is used.

## Contribution

The study clarifies that preoperative biliary drainage does not worsen liver failure outcomes when combined with portal vein embolization and proper antimicrobial use.

## Key findings

- PBD was not an independent risk factor for post-hepatectomy liver failure.
- Portal vein embolization and surgical site infection were significant risk factors for liver failure.
- Appropriate antimicrobial prophylaxis mitigates risks associated with PBD in patients undergoing PVE.

## Abstract

The influence of preoperative biliary drainage (PBD) and portal vein embolization (PVE) on the occurrence of post-hepatectomy liver failure (PHLF) remains unclear. We evaluated their influence on postoperative outcomes, focusing on PHLF, in patients who underwent major hepatectomy for perihilar cholangiocarcinoma (PHCC).

A total of 240 patients underwent major hepatectomy for PHCC between January 1990 and March 2021. We evaluated the influence of PBD on short-term outcomes in all patients and in a subgroup (n = 111) that received PVE.

Although the incidence of grade B/C PHLF in patients with PBD was higher than that in those without PBD, a multivariable analysis identified PVE (OR 3.98, 95% CI 1.9–8.4; p < 0.001) and organ/space surgical site infection (SSI) (OR 3.48, 95% CI 1.6–7.4; p = 0.001), but not PBD, as independent risk factors for grade B/C PHLF. A multivariate analysis of patients who underwent PVE revealed that organ/space SSI was an independent risk factor for grade B/C PHLF (OR 4.5, 95% CI 1.6–12.7; p = 0.005).

PBD did not have a negative impact on the occurrence of PHLF in patients undergoing PVE for an initially inadequate future liver remnant volume, provided that appropriate antimicrobial prophylaxis was selected.

The online version contains supplementary material available at 10.1007/s00595-025-03080-4.