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01-02-2020 | Cholangiocarcinoma

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

Authors: 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, Atsushi Masamune

Published in: Surgical Endoscopy | Issue 2/2020

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.

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Title: Preoperative biliary drainage of the hepatic lobe to be resected does not affect liver hypertrophy after percutaneous transhepatic portal vein embolization
Authors: 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
Atsushi Masamune
Publication date: 01-02-2020
Publisher: Springer US
Keywords: Cholangiocarcinoma
Cholangiocarcinoma
Endoscopic Retrograde Cholangiopancreatography
Published in: Surgical Endoscopy / Issue 2/2020
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-019-06813-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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