PREOPERATIVE BILIARY DRAINAGE FOR HILAR CHOLANGIOCARCINOMA

Abstract

The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 5% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and to perform major surgery only after recovery of the hepatic function. However, no definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus has been reached regarding which PBD method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting and endoscopic nasobiliary drainage in patients with HCA. Recently, a few Japanese high-volume centers have recommended EBD of the future remnant lobe for PBD in patients expected to undergo definitive surgery for HCA. This review summarizes the purpose, transition, current situation, and future of PBD in HCA patients undergoing PBD.