title: Selective versus total biliary drainage for obstructive jaundice caused by a hepatobiliary malignancy.
abstract: BACKGROUND
  Controversy exists regarding which approach is preferable among types of biliary drainage for obstructive jaundice before major hepatectomy: selective biliary drainage (SBD) only on the future remnant liver (FRL) or total biliary drainage (TBD).
  
  
  METHODS
  There were 42 consecutive patients who underwent SBD (n = 15) or TBD (n = 27) for obstructive jaundice caused by a hepatobiliary malignancy, and subsequent portal vein embolization (PVE) before extended hemihepatectomy. The hypertrophy ratio, defined as the ratio of the FRL volume after PVE to that before PVE, was evaluated. The bilirubin clearance also was calculated.
  
  
  RESULTS
  The hypertrophy ratio was higher in patients with SBD than in those with TBD (median, 128%; range, 111-152% vs median, 121%; range, 102-138%; P = .013). The bilirubin clearance of FRL with SBD was markedly improved after PVE compared with that in patients with TBD.
  
  
  CONCLUSIONS
  SBD is superior to TBD in promoting hypertrophy of the FRL induced by PVE and in guaranteeing good liver function before major hepatectomy.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000150:complications*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D004322:Drainage / Q000379:methods*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D011169:Portal Vein; D011300:Preoperative Care; D012189:Retrospective Studies