Differentiated approach to the minimally invasive management of malignant obstructive jaundice

Abstract

Attitude towards preoperative biliary drainage for malignant obstructive jaundice have recently changed twice. This is due certain factors including complications of minimally invasive biliary drainage, level of bile duct block, cholangitis, need for neoadjuvant chemotherapy, time to scheduled surgery, severe general condition of patient, future liver remnant volume. We comprehensively searched PUBMED, MD Consult and National Library of Medicine using the following keywords: “obstructive jaundice (OJ)”, “cellular immunity”, “preoperative biliary drainage”, “selective biliary drainage”, “distal and proximal bile duct block”, “complications”. Randomized clinical trials and meta-analyzes, opinions of reputable specialists in hepatopancreatobiliary surgery and our own experimental and clinical studies were foreground. The analysis showed that preoperative biliary drainage is not a safe procedure and results an increased number of complications. Absolute indications for preoperative biliary drainage are cholangitis, need for neoadjuvant chemotherapy, increased risk of radical surgery and unresectable tumor. Future liver remnant volume should be considered in patients with portal cholangiocarcinoma followed by proximal block to determine indications for preoperative biliary drainage.