Strategy for postoperative infectious complication of biliary cancer by preoperative biliary drainage

Abstract

Surgical resection is only curative method for the patients of biliary cancer. In these patients, obstructive jaundice and cholangitis may occur due to malignant biliary stricture before surgery. Therefore preoperative biliary drainage should be performed for control of biliary infection and appropriate relief of icterus. It have been reported that preoperative biliary drainage is useful for the patients of perihilar cholangiocarcinoma, however there is still unclear that for patients who are performed pancreaticoduodenectomy. Endoscopic drainage is recommended as the method of preoperative biliary drainage compare with percutaneous transhepatic drainage. Prophylactic antimicrobial agents are selected according to the results of a drug susceptibility test of a surveillance of preoperative bile culture because concordance rate between bile juice culture before surgery and bacterial culture from surgical site infection is very high. Comprehension of merits and demerits of preoperative biliary drainage, proper selection of method of drainage, and treatment strategy according to a surveillance of preoperative bile culture, are important for safety surgery for biliary cancer avoiding infectious complication.