Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 14, Issue 5, pp 441–446

Preoperative biliary drainage for hilar cholangiocarcinoma

Authors

  • Hiroyuki Maguchi
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Kuniyuki Takahashi
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Akio Katanuma
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Manabu Osanai
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Kazuyuki Nakahara
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Shinpei Matuzaki
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Takahiro Urata
    • Center for GastroenterologyTeine-Keijinkai Hospital
  • Hirotoshi Iwano
    • Center for GastroenterologyTeine-Keijinkai Hospital
Topics: Recent advanced in treatment of hilar cholangiocarcinoma

DOI: 10.1007/s00534-006-1192-3

Cite this article as:
Maguchi, H., Takahashi, K., Katanuma, A. et al. J Hepatobiliary Pancreat Surg (2007) 14: 441. doi:10.1007/s00534-006-1192-3

Abstract

Hilar cholangiocarcinomas grow slowly, and metastases occur late in the natural history. Surgical cure and long-term survival have been demonstrated, when resection margins are clear. Preoperative biliary drainage has been proposed as a way to improve liver function before surgery, and to reduce post-surgical complications. Percutaneous transhepatic biliary drainage (PTBD) with multiple drains was previously the preferred method for the preoperative relief of obstructive jaundice. However, the introduction of percutaneous transhepatic portal vein embolization (PTPE) and wider resection has changed preoperative drainage strategies. Drainage is currently performed only for liver lobes that will remain after resection, and for areas of segmental cholangitis. Endoscopic biliary drainage (EBD) is less invasive than PTBD. Among EBD techniques, endoscopic nasobiliary drainage (ENBD) is preferable to endoscopic biliary stenting (EBS), because secondary cholangitis (due to the retrograde flow of duodenal fluid into the biliary tree) does not occur. ENBD needs to be converted to PTBD in patients with segmental cholangitis, those with a prolonged need for drainage, or when the extent of longitudinal tumor extension is not sufficiently well characterized.

Key words

Preoperative biliary drainage Hilar cholangiocarcinoma Percutaneous transhepatic biliary drainage Endoscopic biliary drainage Endoscopic nasobiliary drainage Endoscopic biliary stenting

Copyright information

© Springer-Verlag Tokyo 2007