[Portal embolization and second-stage pancreatojejeunostomy improve operative outcomes in patients with advanced biliary carcinoma].
Lethal complications after resection of more than two-thirds of the hepatic parenchyma with pancreatoduodenectomy (PD) are hepatic failure and leakage from pancreatoenterostomy. Twenty-two patients underwent hepatectomy with PD due to advanced biliary carcinoma. Extended hemihepatectomy (EH) with PD was performed in 16 and other types of hepatectomy with PD in 6. The percent volume of the liver to be preserved increased from 31.5% to 43.5% after portal venous branch embolization, which was performed to prevent postoperative hepatic failure. There were no operative and hospital deaths in these 22 patients. Only one patient had a prolonged serum total bilirubin level elevation postoperatively, although the level was less than 5.0 mg/dl. Since leakage from pancreatogastrostomy occurred in 2 of 4 patients who underwent pancreatogastrostomy, second-stage pancreatojejunostomy was chosen to avoid pancreatic fistula in the remaining 18 patients. In 11 patients who underwent EH with PD due to diffuse bile duct carcinoma, the cumulative 1-, 3-, and 5-year survival rates were 90.9%, 64.9%, and 64.9%, respectively. Because EH and PD provides an opportunity for long-term survival for patients with diffuse bile duct carcinoma, prevention of lethal postoperative hepatic failure and leakage from pancreatoenterostomy is important.
Miyagawa
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First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Kawasaki
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D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D006498:Hepatectomy; D006801:Humans; D017093:Liver Failure / Q000209:etiology; D010193:Pancreaticojejunostomy / Q000379:methods / Q000401:mortality*; D011168:Portal System; D015996:Survival Rate; D016896:Treatment Outcome