Original Article
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,
Rohan Jagat Chaudhary
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Search for more papers by this authorRyota Higuchi
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Search for more papers by this authorMasato Nagino
Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorMichiaki Unno
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorMasayuki Ohtsuka
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
Search for more papers by this authorItaru Endo
Department of Gastrointestinal Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Search for more papers by this authorKiyoshi Hasegawa
HPB Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorToshifumi Wakai
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Search for more papers by this authorCorresponding Author
Masakazu Yamamoto
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Correspondence to: Masakazu Yamamoto, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
E-mail: [email protected]
Search for more papers by this authorRohan Jagat Chaudhary,
Ryota Higuchi,
Masato Nagino,
Michiaki Unno,
Masayuki Ohtsuka,
Itaru Endo,
Satoshi Hirano, Katsuhiko Uesaka, Kiyoshi Hasegawa,
Toshifumi Wakai,
Shinji Uemoto, Masakazu Yamamoto,
Rohan Jagat Chaudhary
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Search for more papers by this authorRyota Higuchi
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Search for more papers by this authorMasato Nagino
Nagoya University Graduate School of Medicine, Nagoya, Japan
Search for more papers by this authorMichiaki Unno
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
Search for more papers by this authorMasayuki Ohtsuka
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
Search for more papers by this authorItaru Endo
Department of Gastrointestinal Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Search for more papers by this authorKiyoshi Hasegawa
HPB Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorToshifumi Wakai
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
Search for more papers by this authorCorresponding Author
Masakazu Yamamoto
Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
Correspondence to: Masakazu Yamamoto, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
E-mail: [email protected]
Search for more papers by this authorAbstract
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.
Conflict of interest
None declared.
Supporting Information
| Filename | Description |
|---|---|
| jhbp668-sup-0001-Appendix.docxWord document, 21.9 KB | Appendix S1. Questionnaire. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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