2018 Volume 32 Issue 5 Pages 849-859
As patients with biliary cancer often present obstructive jaundice, preoperative biliary drainage is essential in patients who are to undergo hepatectomy. After biliary drainage, surveillance bile culture is mandatory for selecting appropriate antibiotics. Bile replacement and use of synbiotics are important to maintain intestinal integrity, and pre-rehabilitation are also recommended to prevent sarcopenia, leading to reduce postoperative infectious complications.
Hepatectomy with extrahepatic bile duct resection is complicated and highly invasive. In addition, this procedure is categorized as contaminated surgery, due to intraoperative bile (colonized / infected in many cases) spillage. Based on the results of preoperative bile culture, therefore, antimicrobial prophylaxis should be selected. Recently, one randomized controlled trial clearly demonstrated that two-day administration of antibiotics is enough even in complicated major hepatectomy for biliary cancer. After hepatectomy, early enteral feeding with synbiotics and rehabilitation are also imoportant under the concept of enhanced recovery after surgery (ERAS).
