Primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma
Open accessAbstract
BACKGROUND: The aim of this study was to investigate the incidence and risk factors of primary and secondary liver failure after major liver resection for perihilar cholangiocarcinoma. METHODS: All patients who underwent a major liver resection for presumed perihilar cholangiocarcinoma between 2000 and 2020 at 2 tertiary-referral hospitals were included. Liver failure was defined according to the International Study Group for Liver Surgery criteria, and only grade B/C was considered clinically relevant. Primary liver failure was defined as failure without any underlying postoperative cause, and secondary liver failure was defined as liver failure with an onset after an underlying postoperative complication as a cause. RESULTS: The incidence of liver failure and 90-day mortality were 20.9% and 17.0% in the 253 included patients, respectively. The incidences of primary liver failure was 9.1% and secondary liver failure was 11.9%. Abdominal sepsis, portal vein thrombosis, and arterial thrombosis were the most frequent causes. The absence of preoperative remnant liver assessment and blood loss were independent risk factors for primary liver failure. Independent risk factors for secondary liver failure were Eastern Cooperative Oncology group performance status, percutaneous biliary drainage, and preoperative cholangitis. CONCLUSION: Liver failure after major liver resection for perihilar cholangiocarcinoma occurred in 1 of every 5 patients. The proposed subdivision into primary and secondary liver failure could help to understand differences in outcomes between centers and help to reduce liver failure.
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Insufficient postoperative liver regeneration can be caused secondarily by infection, especially abdominal sepsis, in addition to limited future liver remnant volume.
“Intriguingly, insufficient postoperative liver regeneration not only occurs due to primarily limited volume (small-for-size) of the future liver remnant (FLR), but can also be caused secondarily by infection, especially abdominal sepsis [5,15].”
From The Role of Perioperative Interleukin-6 Serum Levels on Liver Dysfunction and Infectious Complications After Hepatectomy—A Systematic Review (2025) · cites this paper as [15]
The Results and Discussion report that abdominal sepsis was a frequent cause of secondary liver failure after major liver resection, while inadequate future liver remnant assessment was associated with primary liver failure. The paper does not establish that infection impairs postoperative liver regeneration specifically; its finding concerns liver failure, in patients undergoing resection for perihilar cholangiocarcinoma. (LLM, conf=0.86)
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Research works printed but not linked: 29
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Kofler, A., Trattner, M., Mairinger, V., Urban, I., Søreide, K., Stättner, S., & Primavesi, F. (2025) · Cancers · doi:10.3390/cancers17193120 · Cited by 4 · see citing works
“Avoidance of infections is crucial to ensure an un-complicated regeneration of the FLR and the patient [15].”
- Authors
- van Keulen, A.-M., Buettner, S., Besselink, M. G., Busch, O. R., van Gulik, T. M., IJzermans, J. N. M., de Jonge, J., Polak, W. G., Swijnenburg, R.-J., Erdmann, J. I., Groot Koerkamp, B., & Olthof, P. B.
- Affiliations
- Reinier de Graaf Hospital (NL)
- Amsterdam University Medical Centers (NL)
- Erasmus MC Cancer Institute (NL)
- Corresponding author
- Olthof, Pim B.
- ORCID
- Venue
- Surgery
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 170
- Issue
- 4
- Pages
- 1024-1030
- ISSN
- 0039-6060 (ISSN-L)
- OpenAlex
- W3161886061
- Cited by
- 42
- References
- 0
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 11 · 2023: 5 · 2022: 9 · 2021: 1
- FWCI
- 6.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Surgery (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- Pure Amsterdam UMC (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Cholangiocarcinoma and Gallbladder Cancer Studies
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Gallbladder and Bile Duct Disorders
- Keywords
- hilar cholangiocarcinoma, major hepatectomy, postoperative complications, risk factors, abdominal sepsis, portal vein thrombosis, arterial thrombosis, blood loss, percutaneous biliary drainage, 90-day mortality
- MeSH terms
- Aged, Bile Duct Neoplasms, Female, Follow-Up Studies, Hepatectomy, Humans, Male, Middle Aged, Neoplasm Staging, Netherlands, Postoperative Complications, Retrospective Studies, Time Factors, Incidence, Survival Rate, Treatment Outcome, Liver Failure, Klatskin Tumor, Tertiary Care Centers
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