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The type of preoperative biliary drainage predicts short-term outcome after major hepatectomy

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Abstract

Purpose

Endoscopic nasobiliary drainage (ENBD) is increasingly preferred to percutaneous transhepatic biliary drainage (PTBD) for patients undergoing major hepatectomy including hemihepatectomy or trisectorectomy with extrahepatic bile duct resection. The study was aimed to evaluate whether postoperative outcomes differed according to the types of biliary drainage.

Methods

Patients who underwent major hepatectomy with bile duct resection for biliary tract cancer between December 2000 and March 2015 were classified into four groups according to their initial biliary drainage type. The preoperative management and postoperative morbidity were compared.

Results

Totally, 280 patients were classified into the following groups: no biliary drainage (n = 109), PTBD (n = 99), ENBD (n = 28), and endoscopic retrograde biliary drainage (ERBD; n = 44). Preoperative catheter management including tube exchange or additional tube placement due to cholangitis or poor drainage was most frequently required in the ERBD group (PTBD, 18 %; ENBD, 14 %; ERBD, 43 %; P < 0.01). By the time of hepatectomy, 141 patients underwent at least one PTBD (PTBD(+)) and 30 patients were managed only with endoscopic biliary drainage (PTBD(−)). The incidence of major postoperative morbidities (Clavien-Dindo grade ≥ III) in PTBD(+) and PTBD(−) group was 23 and 3 %, respectively (P = 0.01). A multivariate analysis among 171 patients with biliary drainage showed PTBD(+) (P = 0.04; odds ratio = 8.50; 95 % confidential interval [CI], 1.10–65.45) and red blood cells transfusion (P < 0.01; odds ratio = 2.72; 95 % CI, 1.22–6.09) were independent predictors of major morbidity.

Conclusion

The type of preoperative biliary drainage was associated with the perioperative outcomes of major hepatectomy. Sticking to endoscopic biliary drainage was associated with lower risk of postoperative major morbidity.

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Acknowledgments

This work was supported by a Practical Research for Innovative Cancer Control (15ck0106053h0002) from the Japan Agency for Medical Research and Development, AMED.

Authors’ contributions

Study conception and design: Kishi Y, Shimada K

Acquisition of data: Kishi Y, Shimada K, Nara S, Esaki M, Kosuge T

Analysis and interpretation of data: Kishi Y, Nara S, Esaki M

Drafting of manuscript: Kishi Y

Critical revision of manuscript: Kishi Y, Shimada K, Nara S, Esaki M, Kosuge T

Author information

Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki & Tomoo Kosuge

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  1. Yoji Kishi
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  2. Kazuaki Shimada
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  3. Satoshi Nara
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  4. Minoru Esaki
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  5. Tomoo Kosuge
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Corresponding author

Correspondence to Yoji Kishi.

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Conflict of interest

Shimada K. has received research grant from Japan Agency for Medical Research and Development, AMED (#15ck0106053h0002). All other authors declare that they have no conflict of interest.

Human and animal rights and informed consent

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual patients before biliary drainage and surgical procedures included in this study.

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Kishi, Y., Shimada, K., Nara, S. et al. The type of preoperative biliary drainage predicts short-term outcome after major hepatectomy. Langenbecks Arch Surg 401, 503–511 (2016). https://doi.org/10.1007/s00423-016-1427-y

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  • DOI: https://doi.org/10.1007/s00423-016-1427-y

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