Outcome of extended right hepatectomy after biliary drainage in hilar bile duct cancer.

OBJECTIVE: Evaluation of extended right hepatectomy (ERH) after biliary drainage in patients with hilar bile duct cancer.
DESIGN: Case series.
SETTING: University hospital. PATIENTS: Extended right hepatectomy was performed in 25 patients, and 12 underwent other surgical procedures.
INTERVENTIONS: Among the 25 patients, 16 had obstructive jaundice. After biliary drainage, 11 had no biliary stasis in both lobes and five had undrained biliary trees in the right lobe. MAIN OUTCOME MEASURES: Long-term disease-free survival, presence or absence of undrained biliary trees in each lobe, rate of decrease in serum total bilirubin levels, and future remnant liver (left lobe) volume.
RESULTS: Patients who underwent ERH had significantly longer disease-free survival than patients who underwent other procedures. There were no hospital deaths and no significant differences in morbidity between patients with and without prior jaundice. Patients with an undrained biliary tree in the right lobe had a larger future remnant liver volume, a slower rate of decrease in serum total bilirubin levels after biliary drainage, and a more rapid return of the postoperative serum total bilirubin level to the normal range than patients without biliary stasis in both lobes.
CONCLUSIONS: Extended right hepatectomy can be performed safely even in patients showing a very slow decrease in the serum total bilirubin level after biliary drainage, caused by the presence of an undrained biliary tree in the right lobe with no biliary stasis in the left lobe, which induces compensatory hypertrophy of the left lobe. Extended right hepatectomy is a suitable surgical choice for achieving long-term survival in patients with hilar bile duct cancer.