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Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high‐volume centers with a combined experience of 2,778 cases
Author(s) -
Chaudhary Rohan Jagat,
Higuchi Ryota,
Nagino Masato,
Unno Michiaki,
Ohtsuka Masayuki,
Endo Itaru,
Hirano Satoshi,
Uesaka Katsuhiko,
Hasegawa Kiyoshi,
Wakai Toshifumi,
Uemoto Shinji,
Yamamoto Masakazu
Publication year - 2019
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.668
Subject(s) - medicine , perioperative , biliary drainage , liver function , radiology , indocyanine green , cholangiography , surgery , gastroenterology
Background In Japan, strategies for preoperative management of perihilar cholangiocarcinoma ( PHC ) have evolved over the last decade; the operative mortality has significantly reduced to <5%. Methods A questionnaire was sent to 10 institutions based on their case volume. Questionnaire was based on: (1) preoperative biliary drainage, (2) bile replacement, (3) role of synbiotics, (4) remnant liver volume enhancement, (5) predicted remnant liver function, (6) imaging, (7) nutrition, and (8) role of Inchinkoto. Results The median case volume was 226 (range 105–889) cases, respectively. Eight institutions preferred endoscopic nasobiliary drainage and two preferred endoscopic biliary stenting for biliary drainage. Nine used bile replacement within 2–3 days of biliary drainage. Four used synbiotics preoperatively. The median cutoff value for future remnant liver volume and serum total bilirubin, at which portal vein embolization ( PVE ) is done, is <40% and <4 mg/dl. The median interval between PVE and surgery was 3–4 weeks. To predict remnant liver function, indocyanine green retention ( n = 8) and clearance rate ( n = 2) were mainly used. Five used Inchinkoto to improve liver function. Nine used multidetector computed tomography and direct cholangiography for surgical planning. Conclusion With appropriate preoperative management of PHC , surgical morbidity and mortality can be reduced. This survey can provide recommendations to improve PHC perioperative outcomes.