Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer
S. Miyagawa, M. Makuuchi and S. Kawasaki
First Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Japan.
OBJECTIVE: Evaluation of extended right hepatectomy (ERH) after biliary
drainage in patients with hilar bile duct cancer. DESIGN: Case series.
SETTING: University hospital. PATIENTS: Extended right hepatectomy was
performed in 25 patients, and 12 underwent other surgical procedures.
INTERVENTIONS: Among the 25 patients, 16 had obstructive jaundice. After
biliary drainage, 11 had no biliary stasis in both lobes and five had
undrained biliary trees in the right lobe. MAIN OUTCOME MEASURES: Long-term
disease-free survival, presence or absence of undrained biliary trees in
each lobe, rate of decrease in serum total bilirubin levels, and future
remnant liver (left lobe) volume. RESULTS: Patients who underwent ERH had
significantly longer disease-free survival than patients who underwent
other procedures. There were no hospital deaths and no significant
differences in morbidity between patients with and without prior jaundice.
Patients with an undrained biliary tree in the right lobe had a larger
future remnant liver volume, a slower rate of decrease in serum total
bilirubin levels after biliary drainage, and a more rapid return of the
postoperative serum total bilirubin level to the normal range than patients
without biliary stasis in both lobes. CONCLUSIONS: Extended right
hepatectomy can be performed safely even in patients showing a very slow
decrease in the serum total bilirubin level after biliary drainage, caused
by the presence of an undrained biliary tree in the right lobe with no
biliary stasis in the left lobe, which induces compensatory hypertrophy of
the left lobe. Extended right hepatectomy is a suitable surgical choice for
achieving long-term survival in patients with hilar bile duct cancer.
