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.

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.