Comparison of the preoperative transpapillary unilateral biliary drainage methods for the future remnant liver in patients with hilar cholangiocarcinoma

Object: Transpapillary preoperative biliary drainage (PBD) only for the future remnant liver (FRL) in hilar cholangiocarcinoma (HCCA) can be performed minimally invasively, with the expectation of swelling of the FRL. However, verification of the appropriate transpapillary unilateral PBD method for FRL is limited. Methods: Twelve unilateral across-the-papilla plastic stent placement cases (PS group), 14 unilateral intraductal plastic stent placement cases (IS group), and 11 unilateral endoscopic nasobiliary drainage cases (ENBD group) met the inclusion criteria. Each group was compared regarding thehospital stay duration, recurrent biliary obstruction (RBO), time to RBO (TRBO), and surgical outcomes. Results: No significant differences were observed in the patient characteristics between the groups. Hospital stay for the endoscopic procedure was significantly longer in the ENBD group (50[33-163]days) than in the PS group (14[2-36]days; P <0.01) or IS group (21[6-118]days; P <0.01). There were no significant differences in the RBO, TRBO, surgical time, amount of intraoperative blood loss, or post-surgical adverse events (AEs) between the groups. Conclusions: PS, IS, and ENBD groups showed similar clinical outcomes in liver resection cases for HCCA, excluding the hospital stay duration for the endoscopic procedure. Considering the hospital stay duration, unilateral PS and IS placement can be considered acceptable for transpapillary PBD. Clinical Trial Registration: UMIN000052598