title: Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer.
abstract: BACKGROUND
  Patients with perihilar cholangiocarcinoma and gallbladder cancer extending into the hilum often present with jaundice and a small future liver remnant (FLR). If resectable, preoperative biliary drainage and portal vein embolization (PVE) are indicated. Classically, these measures have been performed sequentially, separated by 4-6 weeks.
  
  
  OBJECTIVE
  To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process.
  
  
  METHODS
  Six patients were treated with concurrent PTBD and PVE under general anesthesia.
  
  
  RESULTS
  Surgical exploration followed the combined procedure after 35 days (range, 28-51 days). The FLR ratio increased from 22% to 32%. Three patients developed cholangitis after the procedure.
  
  
  CONCLUSIONS
  The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Nilsson
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: Sam
authors.initials: S
authors.lastname: Eriksson
authors.affiliation: Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Nørgaard Larsen
authors.affiliation: Department of Radiology, Lund University and Skåne University Hospital, Lund, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Keussen
authors.affiliation: Department of Vascular and Interventional Radiology, Rigshospitalet, Faculty of Health Sciences, University Hospital of Copenhagen, Copenhagen, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Christiansen Frevert
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
authors.forename: Gert
authors.initials: G
authors.lastname: Lindell
authors.affiliation: Department of Surgery, Skåne University Hospital, Lund, Sweden ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden ; Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Sturesson
keywords: Abdomen/GI; drainage; embolization