Background/purpose Both curative resection and minimized in-hospital mortality offer the only chance of longterm survival in patients with hilar cholangiocarcinoma. The reported resectability rates for hilar cholangiocarcinoma have increased by virtue of combined major hepatectomy, but this procedure is technically demanding and still associated with a significant morbidity and mortality that must be carefully balanced against the chances of longterm survival. Methods Between January 2001 and December 2008, 350 patients with hilar cholangiocarcinoma underwent exploration for the purpose of potentially curative resection, of whom 302 (86.3%) were resected in the Department of Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine. Combined hepatectomy was carried out in 268 (88.7%) of 302 resected patients. Major hemihepatectomy and parenchyma-preserving hepatectomy were performed in 257 and 11 patients, respectively. Portal vein resection was associated in 40 (14.9%) of 268 hepatectomized patients.To control preoperative cholangitis and reduce risk of postoperative hepatic failure, biliary decompression through endoscopic and/or percutaneous transhepatic drainage and portal vein embolization were preoperatively applied in 329 (94.0%) of 350 explored patients and in 91 (54.2%) of 168 extended hepatectomized patients (154 right hemihepatectomy, 9 right trisectionectomy, 5 left trisectionectomy), respectively. Liver transplantation was not performed as primary treatment for hilar cholangiocarcinoma. Results There were 5 cases (1.7%) of in-hospital death after resection and 1 postoperative liver failure that was successfully treated with liver transplantation. Major complications were encountered in 23 patients (7.0%), and the overall morbidity rate was 43%. In 302 resections, 214 (70.9%) were curative resections (R0) and 88 (29.1%) were palliative resections (R1). The overall 1-, 3-and 5-year survival rates after resection, including in-hospital deaths, were 84.6, 50.7 and 47.3% in the R0 group and 69.9, 33.3 and 7.5% in the R1 group, respectively. The 5-year survival rate of extended hemihepatectomy of 36.4% was better than that of parenchyma-preserving hepatectomy at 10.5%. Two significant predictive factors adversely affecting survival after resection were lymph node metastasis and incurability of surgery (P \ 0.001). Two patients with vascular involvement who underwent concomitant hepatic artery and portal vein reconstruction are alive after more than 3 years. Conclusion Preoperative biliary decompression and portal vein embolization enabled us to reduce in-hospital deaths associated with extended hepatectomy for hilar cholangiocarcinoma. Major hemihepatectomy offers an increased survival because of the higher possibility of curative resection than bile duct resection alone and parenchyma-preserving hepatectomy, but it still carries a certain mortality. Less extensive procedures can be

Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs.

Vascular plug-assisted RTO is technically simple and safe and seems to be clinically effective for treatment of GV and HE.

No abstract

Hepatic arterial injury is a relatively rare complication of PTBD. Because left-sided PTBD is the only independent risk factor associated with hepatic arterial injury, right-sided PTBD is preferable unless technical difficulty or secondary intervention necessitates left-sided PTBD. Moreover, transcatheter arterial embolization is a safe and effective method for treating hepatic arterial injury following PTBD.

Percutaneous transhepatic treatment may be effective in patients with bile leaks after living donor liver transplantation (LDLT). We therefore evaluated the clinical efficacy of percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients. Twenty-three LDLT recipients underwent percutaneous transhepatic treatment to manage bile leaks. The treatment included percutaneous transhepatic biliary drainage (PTBD) and drainage of perihepatic biloma. In patients with combined biliary strictures, balloon dilation was usually performed. Indications for PTBD included patients who had a Roux-en-Y hepaticojejunostomy (n ϭ 9), failed endoscopic cannulation of bile ducts (n ϭ 6), a bile leak refractory to endoscopic management (n ϭ 5), and a poor general condition for endoscopic management (n ϭ 3). Clinical success was achieved in 16 of 23 (70%) patients. PTBD catheters were removed from 14 of the 16 patients with clinical success at a median of 8 months (range, 3-42 months) after initial PTBD. Aside from 1 patient with intrahepatic pseudoaneurysms, there were no major complications. During a median follow-up period of 42 months (range, 3.0-84 months), 6 (43%) of the 14 patients who underwent PTBD catheter removal experienced jaundice or cholangitis due to biliary anastomotic stricture at a median of 26 months (range, 22-49 months) after PTBD catheter removal. In conclusion, percutaneous transhepatic treatment for biliary leaks in adult-to-adult LDLT recipients is clinically effective. This approach is a valuable alternative for treating bile leaks Bile leaks are an important cause of morbidity and mortality following living donor liver transplantation (LDLT) and usually require therapy, including percutaneous interventions, endoscopic management, and reoperations. 1 Endoscopic treatment has largely replaced reoperation as the initial treatment of bile leaks in patients who have previously undergone duct-to-duct (D-D) biliary reconstruction. 2,3 However, endoscopic treatment is difficult in patients who have previously undergone Roux-en-Y hepaticojejunostomy (RYHJ). In addition, endoscopic cannulation of the ampulla of Vater or tight biliary strictures is often difficult or even impossible. 2 In such situations, percutaneous transhepatic treatment may be a good alternative.We therefore retrospectively evaluated the clinical efficacy of percutaneous transhepatic treatment in patients who had bile leaks following adult-to-adult LDLT. PATIENTS AND METHODS Patient PopulationFrom May 1999 to July 2005, bile leaks occurred in 46 (5.4%) of 856 patients who underwent adult-to-adult LDLT at our institution. Of 46 patients, 12 patients underwent endoscopic nasobiliary drainage, 9 underwent percutaneous drainage of biloma only, 2 underwent surgical repair, and the remaining 23 patients

TACE is safe and may be effective for prolonging the survival of patients with nonresectable combined HCC-cholangiocarcinoma, as compared with the historically reported survivals of these patients. Tumor vascularity is highly associated with tumor response. The patient survival period after TACE for combined HCC-cholangiocarcinoma is significantly dependent on tumor size, tumor vascularity, Child-Pugh class, and presence or absence of portal vein invasion.

Percutaneous transhepatic stent placement can be safe and effective in relieving portal venous stenosis after curative surgery for pancreatic and biliary neoplasms. Patients with benign stenosis had more favorable results than did those with tumor recurrence.