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. PURPOSE To report on a new regime where percutaneous transhepatic biliary drainage (PTBD) and PVE are performed simultaneously, shortening the preoperative process. MATERIAL AND 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. CONCLUSION The combined approach of PTBD and PVE seems feasible, but more studies on morbidity are warranted.