World Journal of Surgery

, Volume 42, Issue 11, pp 3676–3684 | Cite as

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

  • Isamu Hosokawa
  • Hiroaki Shimizu
  • Hideyuki Yoshitomi
  • Katsunori Furukawa
  • Tsukasa Takayashiki
  • Masaru Miyazaki
  • Masayuki OhtsukaEmail author
Original Scientific Report



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.


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.


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).


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


Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Supplementary material

268_2018_4654_MOESM1_ESM.pptx (913 kb)
Supplemental Fig. 1. Multidetector-row computed tomography (MDCT) before and after biliary drainage. (A) Dilatation of the bile duct on multidetector-row computed tomography (MDCT) before biliary drainage enables us to diagnose vertical tumor extension (arrow) and longitudinal tumor extension (arrowhead) and to assess the three-dimensional (3D) anatomy at the hepatic hilus. (B) On multidetector-row computed tomography (MDCT) after biliary drainage, the diagnosis of tumor extension and the evaluation of three-dimensional (3D) anatomy of the hepatic hilus are quite difficult due to the disappearance of bile duct dilatation and the stent artifact (arrowhead). Supplemental Fig. 2. Surgical planning of perihilar cholangiocarcinoma (PHC) according to the timing of multidetector-row computed tomography (MDCT). (A) MDCT before biliary drainage, (B) MDCT after biliary drainage. ENBD, endoscopic nasobiliary drainage; PVE, portal vein embolization; MRCP, magnetic resonance cholangiopancreatography. Supplemental Fig. 3. Biliary MDCT (A) was fused with vascular MDCT (B) using a workstation to evaluate the positional relationships between the bile duct, portal vein, and hepatic artery (C). (PPTX 912 kb)


  1. 1.
    Miyazaki M, Kato A, Ito H et al (2007) Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 141:581–588CrossRefGoogle Scholar
  2. 2.
    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 49:435–439CrossRefGoogle Scholar
  3. 3.
    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 17:470–475CrossRefGoogle Scholar
  4. 4.
    Shimizu H, Kimura F, Yoshidome H et al (2010) Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance. Ann Surg 251:281–286CrossRefGoogle Scholar
  5. 5.
    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 259:1178–1185CrossRefGoogle Scholar
  6. 6.
    Poruk KE, Pawlik T, Weiss MJ (2015) Perioperative management of hilar cholangiocarcinoma. J Gastrointest Surg 19:1889–1899CrossRefGoogle Scholar
  7. 7.
    Unno M, Okumoto T, Katayose Y et al (2007) Preoperative assessment of hilar cholangiocarcinoma by multidetector row computed tomography. J Hepatobiliary Pancreat Surg 14:434–440CrossRefGoogle Scholar
  8. 8.
    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. CrossRefPubMedGoogle Scholar
  9. 9.
    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. CrossRefPubMedGoogle Scholar
  10. 10.
    Aloia TA, Charnsangavej C, Faria S et al (2007) High-resolution computed tomography accurately predicts resectability in hilar cholangiocarcinoma. Am J Surg 193:702–706CrossRefGoogle Scholar
  11. 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. CrossRefPubMedGoogle Scholar
  12. 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. CrossRefPubMedGoogle Scholar
  13. 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 19:179–186CrossRefGoogle Scholar
  14. 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 22:249–273CrossRefGoogle Scholar
  15. 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 22:274–278CrossRefGoogle Scholar
  16. 16.
    (UICC) International Union Against Cancer (2009) TNM classification of malignant tumors, 7th edn. Wiley, New YorkGoogle Scholar
  17. 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 267:338–345CrossRefGoogle Scholar
  18. 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 266:126–132CrossRefGoogle Scholar
  19. 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 240:205–213CrossRefGoogle Scholar
  20. 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 258:129–140CrossRefGoogle Scholar
  21. 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 26:1930–1935CrossRefGoogle Scholar
  22. 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 13:277–285PubMedGoogle Scholar
  23. 23.
    Endo I, Matsuyama R, Mori R et al (2014) Imaging and surgical planning for perihilar cholangiocarcinoma. J Hepatobiliary Pancreat Sci 21:525–532CrossRefGoogle Scholar
  24. 24.
    Nagino M (2013) Perihilar cholangiocarcinoma: a surgeon’s viewpoint on current topics. J Gastroenterol 47:1165–1176CrossRefGoogle Scholar
  25. 25.
    Mansour JC, Aloia TA, Crane CH et al (2015) Hilar cholangiocarcinoma: expert consensus statement. HPB 17:691–699CrossRefGoogle Scholar
  26. 26.
    Takahashi Y, Nagino M, Nishio H et al (2010) Percutaneous transhepatic biliary drainage catheter tract recurrence in cholangiocarcinoma. Br J Surg 97:1860–1866CrossRefGoogle Scholar
  27. 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 46:242–248CrossRefGoogle Scholar
  28. 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 161:394–404CrossRefGoogle Scholar
  29. 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 21:533–540CrossRefGoogle Scholar
  30. 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 202:441–448CrossRefGoogle Scholar
  31. 31.
    Parikh AA, Abdalla EK, Vauthey JN (2005) Operative considerations in resection of hilar cholangiocarcinoma. HPB 7:254–258CrossRefGoogle Scholar
  32. 32.
    Rosen CB, Heimbach JK, Gores GJ (2010) Liver transplantation for cholangiocarcinoma. Transpl Int 23:692–697CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Isamu Hosokawa
    • 1
  • Hiroaki Shimizu
    • 1
  • Hideyuki Yoshitomi
    • 1
  • Katsunori Furukawa
    • 1
  • Tsukasa Takayashiki
    • 1
  • Masaru Miyazaki
    • 2
  • Masayuki Ohtsuka
    • 1
    Email author
  1. 1.Department of General SurgeryChiba University Graduate School of MedicineChuo-kuJapan
  2. 2.Mita HospitalInternational University of Health and WelfareTokyoJapan

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