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Preoperative biliary drainage for hilar cholangiocarcinoma
Author(s) -
Maguchi Hiroyuki,
Takahashi Kuniyuki,
Katanuma Akio,
Osanai Manabu,
Nakahara Kazuyuki,
Matuzaki Shinpei,
Urata Takahiro,
Iwano Hirotoshi
Publication year - 2007
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-006-1192-3
Subject(s) - medicine , biliary drainage , percutaneous , drainage , surgery , jaundice , radiology , embolization , biliary tract , portal vein , ecology , biology
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.