Concurrent biliary drainage and portal vein embolization in preparation for extended hepatectomy in patients with biliary cancer.

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. PURPOSE:To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process. MATERIAL AND 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. CONCLUSION:The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.