Assistant Professor (Ad Hoc) Tata Memorial Hospital Mumbai , Maharashtra, India
Background A postoperative biliary leak is one of the most morbid complications occurring after a liver resection. Although peri-operative complications after oncologic liver resections have been associated with inferior survival outcomes in published literature, the long-term impact of post-hepatectomy biliary leaks (PHBL) remains unknown. Methods A retrospective analysis of consecutive liver resections done at our institute from 01.01.2011 to 31.12.2021 was performed. PHBL was classified according to IGSLS definition. .Primary end-point of disease-free survival (DFS) was compared between patients with and without a PHBL after stratifying for tumour type. Survival curves were plotted using Kaplan- Meier estimates, and differences between them were analyzed by using the log-rank test. Results- 862 patients were analysed which included 306 (35.5%)hepatocellular carcinomas (HCC), 212 (24.6%)colorectal liver metastases (CLRM), 69 (8%) intrahepatic cholangiocarcinomas (ihCC), 42 (4.9%)perihilar cholangiocarcinomas (phCC), 75 (8.7%) benign cases and 158 (18.3%) of other metastasis. 449 (52.1%) patients underwent a major hepatic resection (3 or more segments resected). PHBL was seen in 146 (16.9%) patients of whom 85 (9.86%) had grade A, 52 (6.03%) had grade B, and 9 (1.04%) had grade C bile leaks. Occurrence of a PHBL was associated with significantly poorer survival only in patients with a phCC (median DFS 8.9 months vs26.4months, X2= 4.7,p=0.03). Conclusions- Post-hepatectomy biliary leaks are associated with significantly poorer disease- free survival in patients with perihilar cholangiocarcinomas. Methods to mitigate this survival detriment by either delivering systemic therapy in neoadjuvant setting in patients at high risk for bile leak or intensification of consolidation therapy need to be explored