title: Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer.
abstract: OBJECTIVE
  Evaluation of extended right hepatectomy (ERH) after biliary drainage in patients with hilar bile duct cancer.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Extended right hepatectomy was performed in 25 patients, and 12 underwent other surgical procedures.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: First Department of Surgery, Shinshu University, School of Medicine, Matsumoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Miyagawa
authors.forename: M
authors.initials: M
authors.lastname: Makuuchi
authors.forename: S
authors.initials: S
authors.lastname: Kawasaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000097:blood / Q000601:surgery*; D001663:Bilirubin / Q000097:blood; D004322:Drainage; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin