The Type of Preoperative Biliary Drainage Predicts Short-term Outcome After Major Hepatectomy

Purpose: Endoscopic nasobiliary drainage (ENBD) is increasingly preferred to percutaneous transhepatic biliary drainage (PTBD) for patients undergoing major hepatectomy including hemihepatectomy or trisectorectomy with extrahepatic bile duct resection. The study was aimed to evaluate whether postoperative outcomes differed according to the types of biliary drainage.

Methods: Patients who underwent major hepatectomy with bile duct resection for biliary tract cancer between December 2000 and March 2015 were classified into four groups according to their initial biliary drainage type. The preoperative management and postoperative morbidity were compared.

Results: Totally, 280 patients were classified into the following groups: no biliary drainage (n = 109), PTBD (n = 99), ENBD (n = 28), and endoscopic retrograde biliary drainage (ERBD; n = 44). Preoperative catheter management including tube exchange or additional tube placement due to cholangitis or poor drainage was most frequently required in the ERBD group (PTBD, 18 %; ENBD, 14 %; ERBD, 43 %; P < 0.01). By the time of hepatectomy, 141 patients underwent at least one PTBD (PTBD(+)) and 30 patients were managed only with endoscopic biliary drainage (PTBD(-)). The incidence of major postoperative morbidities (Clavien-Dindo grade ≥ III) in PTBD(+) and PTBD(-) group was 23 and 3 %, respectively (P = 0.01). A multivariate analysis among 171 patients with biliary drainage showed PTBD(+) (P = 0.04; odds ratio = 8.50; 95 % confidential interval [CI], 1.10-65.45) and red blood cells transfusion (P < 0.01; odds ratio = 2.72; 95 % CI, 1.22-6.09) were independent predictors of major morbidity.

Conclusion: The type of preoperative biliary drainage was associated with the perioperative outcomes of major hepatectomy. Sticking to endoscopic biliary drainage was associated with lower risk of postoperative major morbidity.