Prediction of risk in biliary surgery

Blamey, Stephen; Fearon, Kenneth C. H.; Gilmour, W H; Osborne, D. H.; Carter, David

doi:10.1002/bjs.1800700910

Cited by 202 publications

(90 citation statements)

References 17 publications

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“…59,60 Most patients with hilar CCA show liver dysfunction caused by obstructive jaundice, which has proven to be a significant risk factor in major liver resection. [61][62][63] As mentioned earlier, animal studies concerning PBD are convincing in terms of complication reduction; clinical studies report conflicting results. [64][65][66][67] Two randomized controlled trials, in which a PBD strategy was compared to early-surgery strategy in jaundiced patients, including patients with proximal lesions, did not display a difference in perioperative mortality; however, they encountered a high rate of PBD-procedure-related complications.…”

Section: Pbd For Proximal Obstructionmentioning

confidence: 88%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

159

114

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Rationale Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial results: improved liver function and nutritional status; reduction of systemic endotoxemia; cytokine release; and, as a result, an improved immune response. Mortality was significantly reduced in these animal models. Human studies show conflicting results. Findings For distal obstruction, currently the "best-evidence" available clearly shows that routine PBD does not yield the appreciated improvement in postoperative morbidity and mortality in patients undergoing resection. Moreover, PBD harbors its own complications. However, most of the available data are outdated or suffer from methodological deficits. Conclusion The highest level of evidence for PBD to be performed in proximal obstruction, as well as over the preferred mode, is lacking but, nevertheless, assimilated in the treatment algorithm for many centers. Logistics and waiting lists, although sometimes inevitable, could be factors that might influence the decision to opt for PBD, as well as an extended diagnostic workup with laparoscopy (on indication) or scheduled preoperative chemotherapy.

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Section: Pbd For Proximal Obstructionmentioning

confidence: 88%

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Gaag

Kloek

Castro

et al. 2009

Journal of Gastrointestinal Surgery

159

114

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“…common bile duct ligation; Kupffer cells; cytokines; chemokines DEVELOPMENT OF bacteremia, sepsis, and an overwhelming systemic inflammatory response remain major causes of morbidity and mortality in patients with cholestatic liver disease (4,6,27,30,33,37). Numerous experimental studies have demonstrated a profound proinflammatory response following endotoxin challenge, which is marked by an increased production of tumor necrosis factor (TNF)-␣, interleukin (IL)-1, and IL-6 in animals with biliary obstruction (9,14,17,18,28).…”

mentioning

confidence: 99%

LPS-binding protein mediates LPS-induced liver injury and mortality in the setting of biliary obstruction

Minter¹,

Bi²,

Ben-Josef³

et al. 2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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GL. LPS-binding protein mediates LPS-induced liver injury and mortality in the setting of biliary obstruction. Am J Physiol Gastrointest Liver Physiol 296: G45-G54, 2009. First published October 23, 2008 doi:10.1152/ajpgi.00041.2008.-It is generally accepted that low levels of lipopolysaccharide (LPS)-binding protein (LBP) augment the cell's response to LPS, whereas high levels of LBP have been shown to inhibit cell responses to LPS. Clinical studies and in vitro work by our group have demonstrated that, in the setting of liver disease, increased or acute-phase levels of LBP may actually potentiate rather than inhibit an overwhelming proinflammatory response. Therefore, in the present studies we sought to determine the role of acute-phase LBP in mediating morbidity and mortality in animals challenged with LPS in the setting of biliary obstruction. Using LBP-deficient mice and LBP blockade in wild-type mice, we demonstrate that high levels of LBP are deleterious in the setting of cholestasis. Following biliary obstruction and intraperitoneal LPS challenge, hepatic injury, hepatic neutrophil infiltration, and mortality were significantly increased in animals with an intact LBP acute-phase response. Kupffer cell responses from these animals demonstrated a significant increase in several inflammatory mediators, and Kupffer cell-associated LBP appears to be responsible for these differences, at least in part. Our results indicate that the role of LBP signaling in inflammatory conditions is complex and heterogeneous, and elevated levels of LBP are not always protective. Increased LBP production in the setting of cholestatic liver disease appears to be deleterious and may represent a potential therapeutic target for preventing overwhelming inflammatory responses to LPS in this setting.

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“…resection of more than three segment of the liver [47][48][49][50][51] . However, instead of elucidating the benefits of preoperative BD previous reports have emphasized the adverse effects of BD, i.e.…”

Section: Biliary Drainagementioning

confidence: 99%

“…However, instead of elucidating the benefits of preoperative BD previous reports have emphasized the adverse effects of BD, i.e. infectious complications due to bile contamination and tract seeding [47][48][49][50][51][52][53][54][55][56][57][58] . Sewnath et al [56] reviewed and summarized randomized controlled and comparative cohort studies, comparing surgery plus preoperative BD with surgery without preoperative BD, and they performed a metaanalysis of the efficacy of preoperative BD.…”

Section: Biliary Drainagementioning

confidence: 99%

Current surgical treatment for bile duct cancer

Seyama

Makuuchi²

2007

WJG

106

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Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

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Prediction of risk in biliary surgery

Cited by 202 publications

References 17 publications

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

Preoperative Biliary Drainage in Patients with Obstructive Jaundice: History and Current Status

LPS-binding protein mediates LPS-induced liver injury and mortality in the setting of biliary obstruction

Current surgical treatment for bile duct cancer

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