TY - JOUR
T1 - Bismuth classification is associated with the requirement for multiple biliary drainage in preoperative patients with malignant perihilar biliary stricture
AU - Miura, Shin
AU - Kanno, Atsushi
AU - Masamune, Atsushi
AU - Hamada, Shin
AU - Takikawa, Tetsuya
AU - Nakano, Eriko
AU - Yoshida, Naoki
AU - Hongo, Seiji
AU - Kikuta, Kazuhiro
AU - Kume, Kiyoshi
AU - Hirota, Morihisa
AU - Yoshida, Hiroshi
AU - Katayose, Yu
AU - Uuno, Michiaki
AU - Shimosegawa, Tooru
N1 - Publisher Copyright:
© 2014, Springer Science+Business Media New York.
PY - 2015/7/19
Y1 - 2015/7/19
N2 - Background: Single preoperative biliary drainage for malignant perihilar biliary stricture occasionally fails to control jaundice and cholangitis. Multiple biliary drainage is required in such cases, but their clinical background is unclear. We determined the clinical characteristics associated with the requirement for multiple biliary drainage. Methods: The consecutive 122 patients with malignant perihilar biliary stricture were enrolled in a single-center retrospective study. Preoperative biliary drainage was initially performed on the future remnant hepatic lobe. Additional drainage was performed if jaundice failed to improve or cholangitis developed in undrained hepatic lobes. Detailed clinical characteristics and the number of preoperative biliary drainage procedures required before operation were analyzed. Results: Thirty-one patients (25.4 %) initially underwent multiple biliary drainage. However, 69 (56.7 %) required multiple biliary drainage by the time of the operation. In the univariate analysis, the initial serum bilirubin level, cholangitis, percutaneous portal vein embolization, history of inserted endoscopic biliary stenting, length of preoperative period, operative procedure, and Bismuth classification were significant factors. In the multivariate analysis using these factors, Bismuth classification was independently associated with the requirement for multiple biliary drainage. The number of patients who required multiple biliary drainage was higher in those with Bismuth-II (91.9 %), Bismuth-IIIa (65.7 %), and Bismuth-IV (92.9 %) than in those with Bismuth-I (22.2 %) and Bismuth-IIIb (18.2 %). Conclusions: Patients with Bismuth-II, Bismuth-IIIa, and Bismuth-IV are at higher risk for multiple biliary drainage. A strategy based on the Bismuth classification for performing preoperative biliary drainage is important for patients with malignant perihilar biliary stricture.
AB - Background: Single preoperative biliary drainage for malignant perihilar biliary stricture occasionally fails to control jaundice and cholangitis. Multiple biliary drainage is required in such cases, but their clinical background is unclear. We determined the clinical characteristics associated with the requirement for multiple biliary drainage. Methods: The consecutive 122 patients with malignant perihilar biliary stricture were enrolled in a single-center retrospective study. Preoperative biliary drainage was initially performed on the future remnant hepatic lobe. Additional drainage was performed if jaundice failed to improve or cholangitis developed in undrained hepatic lobes. Detailed clinical characteristics and the number of preoperative biliary drainage procedures required before operation were analyzed. Results: Thirty-one patients (25.4 %) initially underwent multiple biliary drainage. However, 69 (56.7 %) required multiple biliary drainage by the time of the operation. In the univariate analysis, the initial serum bilirubin level, cholangitis, percutaneous portal vein embolization, history of inserted endoscopic biliary stenting, length of preoperative period, operative procedure, and Bismuth classification were significant factors. In the multivariate analysis using these factors, Bismuth classification was independently associated with the requirement for multiple biliary drainage. The number of patients who required multiple biliary drainage was higher in those with Bismuth-II (91.9 %), Bismuth-IIIa (65.7 %), and Bismuth-IV (92.9 %) than in those with Bismuth-I (22.2 %) and Bismuth-IIIb (18.2 %). Conclusions: Patients with Bismuth-II, Bismuth-IIIa, and Bismuth-IV are at higher risk for multiple biliary drainage. A strategy based on the Bismuth classification for performing preoperative biliary drainage is important for patients with malignant perihilar biliary stricture.
KW - Cholangiocarcinoma
KW - Cholangitis
KW - Endoscopic naso-biliary drainage
KW - Hepatic resection
KW - Obstructive jaundice
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U2 - 10.1007/s00464-014-3878-y
DO - 10.1007/s00464-014-3878-y
M3 - Article
C2 - 25277483
AN - SCOPUS:84935832278
VL - 29
SP - 1862
EP - 1870
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 7
ER -