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Langenbeck's Archives of Surgery

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01-06-2016 | ORIGINAL ARTICLE

The type of preoperative biliary drainage predicts short-term outcome after major hepatectomy

Authors: Yoji Kishi, Kazuaki Shimada, Satoshi Nara, Minoru Esaki, Tomoo Kosuge

Published in: Langenbeck's Archives of Surgery | Issue 4/2016

Abstract

Purpose

Endoscopic nasobiliary drainage (ENBD) is increasingly preferred to percutaneous transhepatic biliary drainage (PTBD) for patients undergoing major hepatectomy including hemihepatectomy or trisectorectomy with extrahepatic bile duct resection. The study was aimed to evaluate whether postoperative outcomes differed according to the types of biliary drainage.

Methods

Patients who underwent major hepatectomy with bile duct resection for biliary tract cancer between December 2000 and March 2015 were classified into four groups according to their initial biliary drainage type. The preoperative management and postoperative morbidity were compared.

Results

Totally, 280 patients were classified into the following groups: no biliary drainage (n = 109), PTBD (n = 99), ENBD (n = 28), and endoscopic retrograde biliary drainage (ERBD; n = 44). Preoperative catheter management including tube exchange or additional tube placement due to cholangitis or poor drainage was most frequently required in the ERBD group (PTBD, 18 %; ENBD, 14 %; ERBD, 43 %; P < 0.01). By the time of hepatectomy, 141 patients underwent at least one PTBD (PTBD(+)) and 30 patients were managed only with endoscopic biliary drainage (PTBD(−)). The incidence of major postoperative morbidities (Clavien-Dindo grade ≥ III) in PTBD(+) and PTBD(−) group was 23 and 3 %, respectively (P = 0.01). A multivariate analysis among 171 patients with biliary drainage showed PTBD(+) (P = 0.04; odds ratio = 8.50; 95 % confidential interval [CI], 1.10–65.45) and red blood cells transfusion (P < 0.01; odds ratio = 2.72; 95 % CI, 1.22–6.09) were independent predictors of major morbidity.

Conclusion

The type of preoperative biliary drainage was associated with the perioperative outcomes of major hepatectomy. Sticking to endoscopic biliary drainage was associated with lower risk of postoperative major morbidity.

Povoski SP, Karpeh MS Jr, Conlon KC, Blumgart LH, Brennan MF (1999) Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 230(2):131–142CrossRefPubMedPubMedCentral

Pisters PW, Hudec WA, Hess KR et al (2001) Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients. Ann Surg 234(1):47–55CrossRefPubMedPubMedCentral

Martignoni ME, Wagner M, Krahenbuhl L et al (2001) Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg 181(1):52–59, discussion 87 CrossRefPubMed

Coates JM, Beal SH, Russo JE et al (2009) Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy. Arch Surg 144(9):841–847. doi:10.1001/archsurg.2009.152 CrossRefPubMed

Mezhir JJ, Brennan MF, Baser RE et al (2009) A matched case–control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg 13(12):2163–2169. doi:10.1007/s11605-009-1046-9 CrossRefPubMed

van der Gaag NA, Rauws EA, van Eijck CH et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362(2):129–137. doi:10.1056/NEJMoa0903230 CrossRefPubMed

Hatfield AR, Tobias R, Terblanche J et al (1982) Preoperative external biliary drainage in obstructive jaundice. A prospective controlled clinical trial. Lancet 2(8304):896–899CrossRefPubMed

McPherson GA, Benjamin IS, Hodgson HJ et al (1984) Pre-operative percutaneous transhepatic biliary drainage: the results of a controlled trial. Br J Surg 71(5):371–375CrossRefPubMed

Pitt HA, Gomes AS, Lois JF et al (1985) Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost? Ann Surg 201(5):545–553CrossRefPubMedPubMedCentral

10.

Hochwald SN, Burke EC, Jarnagin WR, Fong Y, Blumgart LH (1999) Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 134(3):261–266CrossRefPubMed

11.

Cherqui D, Benoist S, Malassagne B et al (2000) Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg 135(3):302–308CrossRefPubMed

12.

Laurent A, Tayar C, Cherqui D (2008) Cholangiocarcinoma: preoperative biliary drainage (Con). HPB (Oxford) 10(2):126–129. doi:10.1080/13651820802007472 CrossRef

13.

Ferrero A, Lo Tesoriere R, Vigano L et al (2009) Preoperative biliary drainage increases infectious complications after hepatectomy for proximal bile duct tumor obstruction. World J Surg 33(2):318–325. doi:10.1007/s00268-008-9830-3 CrossRefPubMed

14.

Seyama Y, Kubota K, Sano K et al (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238(1):73–83PubMedPubMedCentral

15.

Sano T, Shimada K, Sakamoto Y et al (2006) One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann Surg 244(2):240–247. doi:10.1097/01.sla.0000217605.66519.38 CrossRefPubMedPubMedCentral

16.

Nagino M, Takada T, Miyazaki M et al (2008) Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 15(1):25–30. doi:10.1007/s00534-007-1277-7 CrossRefPubMedPubMedCentral

17.

Hirano S, Kondo S, Tanaka E et al (2010) Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci 17(4):455–462. doi:10.1007/s00534-009-0208-1 CrossRefPubMed

18.

Lee SG, Song GW, Hwang S et al (2010) Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 17(4):476–489. doi:10.1007/s00534-009-0204-5 CrossRefPubMed

19.

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(1):129–140. doi:10.1097/SLA.0b013e3182708b57 CrossRefPubMed

20.

Kawashima H, Itoh A, Ohno E et al (2013) Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: a retrospective study of efficacy and risk factors related to complications. Ann Surg 257(1):121–127. doi:10.1097/SLA.0b013e318262b2e9 CrossRefPubMed

21.

Kloek JJ, van der Gaag NA, Aziz Y et al (2010) Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg 14(1):119–125. doi:10.1007/s11605-009-1009-1 CrossRefPubMedPubMedCentral

22.

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(2):242–248. doi:10.1007/s00535-010-0298-1 CrossRefPubMed

23.

Takahashi Y, Nagino M, Nishio H et al (2010) Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 97(12):1860–1866. doi:10.1002/bjs.7228 CrossRefPubMed

24.

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(8):533–540. doi:10.1002/jhbp.76 CrossRefPubMed

25.

Sakamoto Y, Nara S, Kishi Y et al (2013) Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery. doi:10.1016/j.surg.2012.11.024

26.

Shimada K, Nara S, Esaki M et al (2011) Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum. Br J Surg 98(1):117–123. doi:10.1002/bjs.7262 CrossRefPubMed

27.

Esaki M, Shimada K, Nara S et al (2013) Left hepatic trisectionectomy for advanced perihilar cholangiocarcinoma. Br J Surg 100(6):801–807. doi:10.1002/bjs.9099 CrossRefPubMed

28.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. doi:10.1097/SLA.0b013e3181b13ca2 CrossRefPubMed

29.

Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680–688. doi:10.1016/j.surg.2010.12.002 CrossRefPubMed

30.

Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149(5):713–724. doi:10.1016/j.surg.2010.10.001 CrossRefPubMed

31.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13. doi:10.1016/j.surg.2005.05.001 CrossRefPubMed

32.

Bismuth H, Nakache R, Diamond T (1992) Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215(1):31–38CrossRefPubMedPubMedCentral

33.

Farges O, Regimbeau JM, Fuks D et al (2013) Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg 100(2):274–283. doi:10.1002/bjs.8950 CrossRefPubMed

Title: The type of preoperative biliary drainage predicts short-term outcome after major hepatectomy
Authors: Yoji Kishi
Kazuaki Shimada
Satoshi Nara
Minoru Esaki
Tomoo Kosuge
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1427-y

At a glance: The STEP trials

Springer Medicine

The type of preoperative biliary drainage predicts short-term outcome after major hepatectomy

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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