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Preoperative biliary drainage for hilar cholangiocarcinoma

  • Topics: Recent advanced in treatment of hilar cholangiocarcinoma
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

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.

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Authors and Affiliations

  1. Center for Gastroenterology, Teine-Keijinkai Hospital, 1-jo 12-chome, Maeda, Teine-ku, Sapporo, 006-8555, Japan

    Hiroyuki Maguchi, Kuniyuki Takahashi, Akio Katanuma, Manabu Osanai, Kazuyuki Nakahara, Shinpei Matuzaki, Takahiro Urata & Hirotoshi Iwano

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  1. Hiroyuki Maguchi
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  2. Kuniyuki Takahashi
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  3. Akio Katanuma
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  4. Manabu Osanai
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  5. Kazuyuki Nakahara
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  6. Shinpei Matuzaki
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  7. Takahiro Urata
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  8. Hirotoshi Iwano
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Maguchi, H., Takahashi, K., Katanuma, A. et al. Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg 14, 441–446 (2007). https://doi.org/10.1007/s00534-006-1192-3

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  • DOI: https://doi.org/10.1007/s00534-006-1192-3

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