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Journal of Gastrointestinal Surgery

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01-03-2011 | Original Article

Radical Surgery in the Presence of Biliary Metallic Stents: Revising the Palliative Scenario

Authors: Dimitrios Lytras, Steven W. M. Olde Damink, Zahir Amin, Charles J. Imber, Massimo Malagó

Published in: Journal of Gastrointestinal Surgery | Issue 3/2011

Abstract

Background

The application of endobiliary self-expandable metallic stents (SEMS) is considered the palliative treatment of choice in patients with biliary obstruction in the setting of inoperable malignancies. In the presence of SEMS, however, radical surgery is the only curative option when the resectability status is revised in case of malignancies or for overcoming complications arising from their application in benign conditions that masquerade as inoperable tumours. The aim of our study was to report our surgical experience with patients who underwent an operation due to revision of the initial palliative approach, whilst they had already been treated with biliary SEMS exceeding the hilar bifurcation.

Methods

Three patients with hilar cholangiocarcinoma that was considered inoperable and one patient with IgG4 autoimmune cholangio-pancreatopathy mimicking pancreatic cancer underwent radical resections in the presence of biliary SEMS.

Results

After a detailed preoperative workup, two right trisectionectomies, one left extended hepatectomy and a radical extrahepatic biliary resection were performed. All cases demanded resection and reconstruction of the portal vein. R0 resection was achieved in all the malignant cases. Two patients required multiple biliodigestive anastomoses entailing three and seven bile ducts respectively. There was one perioperative death due to postoperative portal vein and hepatic artery thrombosis, whilst two patients developed grade III complications. At follow-up, one patient died at 13 months due to disease recurrence, whilst the remaining two are free of disease or symptoms at 21 and 12 months, respectively.

Conclusions

Revising the initial palliative approach and operating in the setting of biliary metallic stents is extremely demanding and carries significant mortality and morbidity. Radical resection is the only option for offering cure in such complex cases, and this should only be attempted in advanced hepatopancreaticobiliary centres with active involvement in liver transplantation.

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Title: Radical Surgery in the Presence of Biliary Metallic Stents: Revising the Palliative Scenario
Authors: Dimitrios Lytras
Steven W. M. Olde Damink
Zahir Amin
Charles J. Imber
Massimo Malagó
Publication date: 01-03-2011
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 3/2011
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-010-1389-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Radical Surgery in the Presence of Biliary Metallic Stents: Revising the Palliative Scenario

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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