Preoperative Biliary Drainage for Patients with Perihilar Bile Duct Malignancy
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Although endoscopic biliary stenting (EBS) is known to increase preoperative biliary drainage (PBD)-related complications including postoperative surgical site infection (SSI), EBS is still commonly placed before referral to tertiary centers. Whether exchanging EBS with external drainage methods mitigate the risk of SSI is unknown. This study sought to identify EBS-associated risk of recurrent biliary obstruction and postoperative SSI, with particular attention whether it was replaced with external drainage methods before surgery.
From January 2005 to December 2014, 102 consecutive patients with perihilar biliary cancer who underwent PBD followed by hepatobiliary resection were analyzed.
Among the enrolled patients, 49 (48.0%) underwent total 76 re-interventions due to recurrent biliary obstruction with a median number of 1 (range, 1 to 6). Cholangitis occurred more frequently in patients with EBS (26.9%) than in other methods (P < 0.001). The incidence of postoperative SSI was marginally higher among the patients with EBS at the time of surgery than those with previously placed EBS replaced by the external drainage (72.2% vs 38.5%, P = 0.060). In the multivariate analysis, presence of EBS at the time of surgery remained as an only independent predictor of SSI (95% CI, 1.46–17.32; P = 0.011).
The use of EBS increased recurrent biliary obstruction and postoperative SSI particularly when it is present at a time of definitive operation. Our findings support using external drainage such as by endoscopic nasobiliary drainage because of the lower associated incidence of these complications.
KeywordsPreoperative biliary drainage Endoscopic biliary stenting at the time of surgery
YT—conception or design of the work and drafting the work.
HI—conception or design of the work and drafting and critical revision of the work.
YI—conception or design of the work and critical revision of the work.
YO—conception or design of the work and critical revision of the work.
TS—conception or design of the work and critical revision of the work.
AS—conception or design of the work and critical revision of the work.
All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work were appropriately investigated and resolved.
Compliance with Ethical Standards
The Institutional Review Board of the Cancer Institute Hospital approved this study protocol (Approval number 2016-1136).
Conflict of Interest
The authors declare that they have no conflict of interest. This paper has not been previously presented elsewhere.
- 3.Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of Preoperative Biliary Drainage in Jaundiced Patients Who Are Candidates for Pancreatoduodenectomy or Hepatic Resection. Annals of Surgery. 2013;257(2):191–204. https://doi.org/10.1097/SLA.0b013e31826f4b0e.CrossRefGoogle Scholar
- 6.Kloek JJ, van der Gaag NA, Aziz Y, Rauws EAJ, van Delden OM, Lameris JS et al. Endoscopic and Percutaneous Preoperative Biliary Drainage in Patients with Suspected Hilar Cholangiocarcinoma. Journal of Gastrointestinal Surgery. 2009;14(1):119–25. https://doi.org/10.1007/s11605-009-1009-1.CrossRefGoogle Scholar
- 8.Kawakami H, Kuwatani M, Onodera M, Haba S, Eto K, Ehira N et al. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. Journal of Gastroenterology. 2010;46(2):242–8. https://doi.org/10.1007/s00535-010-0298-1.CrossRefGoogle Scholar
- 12.Al Mahjoub A, Menahem B, Fohlen A, Dupont B, Alves A, Launoy G et al. Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis. Journal of Vascular and Interventional Radiology. 2017;28(4):576–82. https://doi.org/10.1016/j.jvir.2016.12.1218.CrossRefGoogle Scholar
- 23.Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011;149(5):680–8. https://doi.org/10.1016/j.surg.2010.12.002.CrossRefGoogle Scholar
- 27.Fujii T, Yamada S, Suenaga M, Kanda M, Takami H, Sugimoto H et al. Preoperative internal biliary drainage increases the risk of bile juice infection and pancreatic fistula after pancreatoduodenectomy: a prospective observational study. Pancreas. 2015;44(3):465–70. https://doi.org/10.1097/MPA.0000000000000265.Google Scholar
- 31.Ribero D, Zimmitti G, Aloia TA, Shindoh J, Forchino F, Amisano M et al. Preoperative Cholangitis and Future Liver Remnant Volume Determine the Risk of Liver Failure in Patients Undergoing Resection for Hilar Cholangiocarcinoma. Journal of the American College of Surgeons. 2016;223(1):87–97. https://doi.org/10.1016/j.jamcollsurg.2016.01.060.CrossRefGoogle Scholar
- 32.Sakata J, Shirai Y, Tsuchiya Y, Wakai T, Nomura T, Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch Surg. 2009;394(6):1065–72. https://doi.org/10.1007/s00423-009-0464-1.CrossRefGoogle Scholar
- 35.Komaya K, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T et al. Verification of the oncologic inferiority of percutaneous biliary drainage to endoscopic drainage: A propensity score matching analysis of resectable perihilar cholangiocarcinoma. Surgery. 2017;161(2):394–404. https://doi.org/10.1016/j.surg.2016.08.008.CrossRefGoogle Scholar
- 36.Inatomi O, Bamba S, Shioya M, Mochizuki Y, Ban H, Tsujikawa T et al. Threaded biliary inside stents are a safe and effective therapeutic option in cases of malignant hilar obstruction. BMC Gastroenterol. 2013;13:31. https://doi.org/10.1186/1471-230X-13-31.1471-230X-13-31
- 37.Kobayashi N, Watanabe S, Hosono K, Kubota K, Nakajima A, Kaneko T et al. Endoscopic inside stent placement is suitable as a bridging treatment for preoperative biliary tract cancer. BMC Gastroenterology. 2015;15(1). https://doi.org/10.1186/s12876-015-0233-2.