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Surgical Endoscopy

, Volume 34, Issue 2, pp 667–674 | Cite as

Preoperative biliary drainage of the hepatic lobe to be resected does not affect liver hypertrophy after percutaneous transhepatic portal vein embolization

  • Shin MiuraEmail author
  • Atsushi Kanno
  • Koji Fukase
  • Yu Tanaka
  • Ryotaro Matsumoto
  • Tatsuhide Nabeshima
  • Seiji Hongou
  • Tetsuya Takikawa
  • Shin Hamada
  • Kiyoshi Kume
  • Kazuhiro Kikuta
  • Kei Nakagawa
  • Michiaki Unno
  • Atsushi Masamune
Article
  • 116 Downloads

Abstract

Background

In patients with malignant perihilar biliary strictures, preoperative biliary drainage (PBD) of the hepatic lobe to be resected may decrease the liver volume of the future liver remnant (FLR) after percutaneous transhepatic portal vein embolization (PVE). However, evidence of its application is insufficient. This study aimed to clarify the effects of PBD on liver hypertrophy after PVE.

Methods

Between January 2008 and December 2017, 169 patients with malignant perihilar biliary strictures underwent major hepatectomy or palliative surgery at our hospital. Of these, 76 patients who underwent PVE were categorized into two groups: group A (n = 29) who received unilateral PBD of the FLR and group B (n = 47) who received bilateral PBD, including that of the hepatic lobe to be resected. FLR ratios after PVE and liver hypertrophy ratios were retrospectively compared in both groups.

Results

Group B exhibited significantly severe biliary stenosis (p = 0.0038) and high serum bilirubin before biliary drainage (p = 0.0037). After PVE, the total liver volumes were 1287 ± 260 ml and 1340 ± 257 ml (p = 0.39), respectively. FLR volumes were 555 ± 135 and 577 ± 113 ml (p = 0.45), respectively. FLR ratios were 43.4 ± 8.2% and 43.4 ± 6.4%, respectively (p = 0.98). Liver hypertrophy ratios were 124.2 ± 17.7% and 129.2 ± 20.9%, respectively (p = 0.28). In addition, an examination which excluded patients with Bismuth type I obtained similar result.

Conclusions

PBD of the hepatic lobe to be resected did not decrease the FLR ratios and hypertrophy ratios. Thus, in patients with poor biliary drainage, additional PBD of the target lobe is acceptable.

Keywords

Cholangiocarcinoma Gallbladder carcinoma Obstructive jaundice Hepatectomy Endoscopic retrograde cholangiopancreatography and biliary drainage 

Notes

Acknowledgements

The authors would like to thank Enago (www.enago.jp) for the English language review.

Compliance with ethical standards

Disclosures

Drs. Shin Miura, Atsushi Kanno, Koji Fukase, Yu Tanaka, Ryotaro Matsumoto, Tatsuhide Nabeshima, Seiji Hongou, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Kei Nakagawa, Michiaki Unno, and Atsushi Masamune have no conflict of interests or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Shin Miura
    • 1
    Email author
  • Atsushi Kanno
    • 1
  • Koji Fukase
    • 2
  • Yu Tanaka
    • 1
  • Ryotaro Matsumoto
    • 1
  • Tatsuhide Nabeshima
    • 1
  • Seiji Hongou
    • 1
  • Tetsuya Takikawa
    • 1
  • Shin Hamada
    • 1
  • Kiyoshi Kume
    • 1
  • Kazuhiro Kikuta
    • 1
  • Kei Nakagawa
    • 3
  • Michiaki Unno
    • 3
  • Atsushi Masamune
    • 1
  1. 1.Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
  2. 2.Department of SurgeryJapanese Red Cross Ishinomaki HospitalIshinomakiJapan
  3. 3.Department of SurgeryTohoku University Graduate School of MedicineSendaiJapan

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