Abstract：
BACKGROUND:Although multidetector-row computed tomography (MDCT) before biliary drainage is useful for the assessment of the resectability of perihilar cholangiocarcinoma (PHC), the impact of biliary drainage on MDCT images before surgical resection for PHC has been poorly studied, and its possible consequences for R0 resection of PHC remain unclear. This study was performed to compare the surgical outcomes of patients with PHC who underwent MDCT before versus after biliary drainage. METHODS:All consecutive patients who underwent major hepatectomy extending to segment 1 with extrahepatic bile duct resection for PHC from 2009 to 2016 were retrospectively evaluated. R0 resection was defined as no residual cancer at all surgical margins. Patients with pathological stage IV PHC were excluded. RESULTS:Of 142 patients who underwent major hepatectomy, 108 were eligible for this study. Of these 108 patients, 64 (59%) and 44 (41%) underwent MDCT before and after biliary drainage, respectively. The total bilirubin concentration at presentation was lower in patients who underwent MDCT before than after biliary drainage (4.1 ± 5.9 vs. 8.0 ± 7.1 mg/ml, respectively; p = 0.002). Although there were no significant differences in the surgical characteristics or pathological stages between the two groups, R0 resection was more frequently achieved in patients who underwent MDCT before than after biliary drainage [46/64 (72%) vs. 22/44 (50%), respectively; p = 0.03]. On multivariate analysis, MDCT before biliary drainage was independently associated with R0 resection of PHC (risk ratio: 2.38, 95% CI 1.05-5.41; p = 0.04). CONCLUSIONS:In selected patients, MDCT should be performed before biliary drainage to achieve R0 resection of PHC.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Hosokawa I,Shimizu H,Yoshitomi H,Furukawa K,Takayashiki T,Miyazaki M,Ohtsuka Mdoi
10.1007/s00268-018-4654-2subject
Has Abstractpub_date
2018-11-01 00:00:00pages
3676-3684issue
11eissn
0364-2313issn
1432-2323pii
10.1007/s00268-018-4654-2journal_volume
42pub_type
杂志文章abstract：:The post-Soviet calamities of East European cardiac surgery highlight the spectrum of marked differences in overall operative capacities among individual post-Communist countries. A comparison with the level of cardiac surgery in Western Europe reveals the importance of continuing relief, comprising both educational a...
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