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 Ohtsuka
Original Scientific Report
  • 61 Downloads

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.

Notes

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)

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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
  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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