IMPACT OF PREOPERATIVE PARAMETERS ON OUTCOMES FOLLOWING LIVER RESECTION FOR BILIARY CANCERS

Abstract

Biliary cancers such as gallbladder carcinoma and cholangiocarcinoma are aggressive hepatobiliary malignancies with poor prognosis because many patients present at an advanced stage. Liver resection remains the only potentially curative treatment, but perioperative outcomes depend on preoperative patient factors, tumor extent, operative complexity, and available biomarker information. In this retrospective, observational study, the effect of preoperative clinical, biochemical, imaging and biomarker variables of liver resection performed for biliary cancers was evaluated from April 2017 to September 2025 at Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi, Pakistan. All 90 patients who underwent liver resection for the treatment of biliary cancers with curative intent were included. These were the parameters evaluated preoperatively: clinical presentation, bilirubin level, alkaline phosphatase, CA 19-9, imaging and ERCP/PTBD status. Operative details, postoperative complications, length of stay in the ICU, requirement for transfusion of blood, histopathology and survival outcome were assessed. The collected data were analysed with SPSS version 25.0. Ninety patients (66.7% males, 60, 33.3% females) were included in the cohort and had a mean age of 59 years. Common presentation was jaundice and weight loss, and the mean level of CA 19-9 was 400 U/mL, supporting the use of this as a useful preoperative biomarker when used with clinical and radiological data. Surgery involved hepatectomy on the right side in 27 patients (30.0%), left side hepatectomy in 21 (23.3%), extended right hepatectomy in 16 (17.8%), extended left hepatectomy in 16 (17.8%) and central hepatectomy in 10 (11.1%). Blood transfusion was needed in 18 (20.0%) patients and the mean length of the ICU stay was 5.4 days, while 6 patients (6.7%) had a bile leak. Liver resection is an important modality for treatment in biliary cancers, and can provide acceptable peri-operative results in a dedicated hepatobiliary centre. The integration of clinical assessment, imaging, biochemical markers and CA 19-9 will have a beneficial impact on patient selection, peri-operative optimization and surgical planning.