Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2,778 cases

Rohan Jagat Chaudhary, Ryota Higuchi, Masato Nagino, Michiaki Unno, Masayuki Ohtsuka, Itaru Endo, Satoshi Hirano, Katsuhiko Uesaka, Kiyoshi Hasegawa, Toshifumi Wakai, Shinji Uemoto, Masakazu Yamamoto

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: In Japan, strategies for preoperative management of perihilar cholangiocarcinoma (PHC) have evolved over the last decade; the operative mortality has significantly reduced to <5%. Methods: A questionnaire was sent to 10 institutions based on their case volume. Questionnaire was based on: (1) preoperative biliary drainage, (2) bile replacement, (3) role of synbiotics, (4) remnant liver volume enhancement, (5) predicted remnant liver function, (6) imaging, (7) nutrition, and (8) role of Inchinkoto. Results: The median case volume was 226 (range 105–889) cases, respectively. Eight institutions preferred endoscopic nasobiliary drainage and two preferred endoscopic biliary stenting for biliary drainage. Nine used bile replacement within 2–3 days of biliary drainage. Four used synbiotics preoperatively. The median cutoff value for future remnant liver volume and serum total bilirubin, at which portal vein embolization (PVE) is done, is <40% and <4 mg/dl. The median interval between PVE and surgery was 3–4 weeks. To predict remnant liver function, indocyanine green retention (n = 8) and clearance rate (n = 2) were mainly used. Five used Inchinkoto to improve liver function. Nine used multidetector computed tomography and direct cholangiography for surgical planning. Conclusion: With appropriate preoperative management of PHC, surgical morbidity and mortality can be reduced. This survey can provide recommendations to improve PHC perioperative outcomes.

Original languageEnglish
Pages (from-to)490-502
Number of pages13
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume26
Issue number11
DOIs
Publication statusPublished - 2019 Nov 1
Externally publishedYes

Keywords

  • Cholangiocarcinoma
  • Management
  • Outcome
  • Surgery
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Hepatology

Fingerprint Dive into the research topics of 'Survey of preoperative management protocol for perihilar cholangiocarcinoma at 10 Japanese high-volume centers with a combined experience of 2,778 cases'. Together they form a unique fingerprint.

Cite this