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01-11-2018 | Original Scientific Report

Impact of Biliary Drainage on Multidetector-Row Computed Tomography on R0 Resection of Perihilar Cholangiocarcinoma

Authors: Isamu Hosokawa, Hiroaki Shimizu, Hideyuki Yoshitomi, Katsunori Furukawa, Tsukasa Takayashiki, Masaru Miyazaki, Masayuki Ohtsuka

Published in: World Journal of Surgery | Issue 11/2018

Abstract

Background

Although multidetector-row computed tomography (MDCT) before biliary drainage is useful for the assessment of the resectability of perihilar cholangiocarcinoma (PHC), the impact of biliary drainage on MDCT images before surgical resection for PHC has been poorly studied, and its possible consequences for R0 resection of PHC remain unclear. This study was performed to compare the surgical outcomes of patients with PHC who underwent MDCT before versus after biliary drainage.

Methods

All consecutive patients who underwent major hepatectomy extending to segment 1 with extrahepatic bile duct resection for PHC from 2009 to 2016 were retrospectively evaluated. R0 resection was defined as no residual cancer at all surgical margins. Patients with pathological stage IV PHC were excluded.

Results

Of 142 patients who underwent major hepatectomy, 108 were eligible for this study. Of these 108 patients, 64 (59%) and 44 (41%) underwent MDCT before and after biliary drainage, respectively. The total bilirubin concentration at presentation was lower in patients who underwent MDCT before than after biliary drainage (4.1 ± 5.9 vs. 8.0 ± 7.1 mg/ml, respectively; p = 0.002). Although there were no significant differences in the surgical characteristics or pathological stages between the two groups, R0 resection was more frequently achieved in patients who underwent MDCT before than after biliary drainage [46/64 (72%) vs. 22/44 (50%), respectively; p = 0.03]. On multivariate analysis, MDCT before biliary drainage was independently associated with R0 resection of PHC (risk ratio: 2.38, 95% CI 1.05–5.41; p = 0.04).

Conclusions

In selected patients, MDCT should be performed before biliary drainage to achieve R0 resection of PHC.

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Miyazaki M, Kato A, Ito H et al (2007) Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–588CrossRef

Shimizu H, Sawada S, Kimura F et al (2009) Clinical significance of biliary vascular anatomy of the right liver for hilar cholangiocarcinoma applied to left hemihepatectomy. Ann Surg 49:435–439CrossRef

Miyazaki M, Kimura F, Shimizu H et al (2010) One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008. J Hepatobiliary Pancreat Sci 17:470–475CrossRef

Shimizu H, Kimura F, Yoshidome H et al (2010) Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance. Ann Surg 251:281–286CrossRef

Hosokawa I, Shimizu H, Yoshidome H et al (2014) Surgical strategy for hilar cholangiocarcinoma of the left-side predominance: current role of left trisectionectomy. Ann Surg 259:1178–1185CrossRef

Poruk KE, Pawlik T, Weiss MJ (2015) Perioperative management of hilar cholangiocarcinoma. J Gastrointest Surg 19:1889–1899CrossRef

Unno M, Okumoto T, Katayose Y et al (2007) Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg 14:434–440CrossRef

Shimizu H, Hosokawa I, Ohtsuka M et al (2014) Clinical significance of anatomical variant of the left hepatic artery for perihilar cholangiocarcinoma applied to right-sided hepatectomy. World J Surg 38:3210–3214. https://doi.org/10.1007/s00268-014-2715-8 CrossRefPubMed

Yoshioka Y, Ebata T, Yokoyama Y et al (2011) Supraportal right posterior hepatic artery: an anatomic trap in hepatobiliary and transplant surgery. World J Surg 35:1340–1344. https://doi.org/10.1007/s00268-011-1075-x CrossRefPubMed

10.

Aloia TA, Charnsangavej C, Faria S et al (2007) High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 193:702–706CrossRef

11.

Senda Y, Nishio H, Oda K et al (2009) Value of multidetector row CT in the assessment of longitudinal extension of cholangiocarcinoma—correlation between MDCT and microscopic findings. World J Surg 33:1459–1467. https://doi.org/10.1007/s00268-009-0025-3 CrossRefPubMed

12.

Sugiura T, Nishio H, Nagino M et al (2008) Value of multidetector-row computed tomography in diagnosis of portal vein invasion by perihilar cholangiocarcinoma. World J Surg 32:1478–1484. https://doi.org/10.1007/s00268-008-9547-3 CrossRefPubMed

13.

Fukami Y, Ebata T, Yokoyama Y et al (2012) Diagnostic ability of MDCT to assess right hepatic artery invasion by perihilar cholangiocarcinoma with left-sided predominance. J Hepatobiliary Pancreat Sci 19:179–186CrossRef

14.

Miyazaki M, Yoshitomi H, Miyakawa S et al (2015) Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. J Hepatobiliary Pancreat Sci 22:249–273CrossRef

15.

Yoshitomi H, Miyakawa S, Nagino M et al (2015) Updated clinical practice guidelines for the management of biliary tract cancers: revision concepts and major revised points. J Hepatobiliary Pancreat Sci 22:274–278CrossRef

16.

(UICC) International Union Against Cancer (2009) TNM classification of malignant tumors, 7th edn. Wiley, New York

17.

Watanabe Y, Kuboki S, Shimizu H et al (2018) A new proposal of criteria for the future remnant liver volume in older patients undergoing major hepatectomy for biliary tract cancer. Ann Surg 267:338–345CrossRef

18.

Tsukahara T, Ebata T, Shimoyama Y et al (2017) Residual carcinoma in situ at the ductal stump has a negative survival effect: an analysis of early-stage cholangiocarcinomas. Ann Surg 266:126–132CrossRef

19.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

20.

Nagino M, Ebata T, Yokoyama Y et al (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 258:129–140CrossRef

21.

Groot Koerkamp B, Wiggers JK, Gonen M et al (2015) Survival after resection of perihilar cholangiocarcinoma: development and external validation of a prognostic nomogram. Ann Oncol 26:1930–1935CrossRef

22.

Itoh S, Ikeda M, Ota T et al (2003) Assessment of the pancreatic and intrapancreatic bile ducts using 0.5-mm collimation and multiplanar reformatted images in multislice CT. Eur Radiol 13:277–285PubMed

23.

Endo I, Matsuyama R, Mori R et al (2014) Imaging and surgical planning for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 21:525–532CrossRef

24.

Nagino M (2013) Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. J Gastroenterol 47:1165–1176CrossRef

25.

Mansour JC, Aloia TA, Crane CH et al (2015) Hilar cholangiocarcinoma: expert consensus statement. HPB 17:691–699CrossRef

26.

Takahashi Y, Nagino M, Nishio H et al (2010) Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 97:1860–1866CrossRef

27.

Kawakami H, Kuwatani M, Onodera M et al (2011) Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 46:242–248CrossRef

28.

Komaya K, Ebata T, Yokoyama Y et al (2017) Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: a propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery 161:394–404CrossRef

29.

Hirano S, Tanaka E, Tsuchikawa T et al (2014) Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 21:533–540CrossRef

30.

Sasaki R, Kondo T, Oda T et al (2011) Impact of three-dimensional analysis of multidetector row computed tomography cholangioportography in operative planning for hilar cholangiocarcinoma. Am J Surg 202:441–448CrossRef

31.

Parikh AA, Abdalla EK, Vauthey JN (2005) Operative considerations in resection of hilar cholangiocarcinoma. HPB 7:254–258CrossRef

32.

Rosen CB, Heimbach JK, Gores GJ (2010) Liver transplantation for cholangiocarcinoma. Transpl Int 23:692–697CrossRef

Title: Impact of Biliary Drainage on Multidetector-Row Computed Tomography on R0 Resection of Perihilar Cholangiocarcinoma
Authors: Isamu Hosokawa
Hiroaki Shimizu
Hideyuki Yoshitomi
Katsunori Furukawa
Tsukasa Takayashiki
Masaru Miyazaki
Masayuki Ohtsuka
Publication date: 01-11-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 11/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4654-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of Biliary Drainage on Multidetector-Row Computed Tomography on R0 Resection of Perihilar Cholangiocarcinoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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