Patient preparation before surgery for cholangiocarcinoma
1Centre de Chirurgie Viscérale et de Transplantation-Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Université Louis Pasteur, Strasbourg, France.
Summary
Preoperative treatments for jaundiced cholangiocarcinoma (CCA) patients undergoing liver resection can improve outcomes. Evidence supports fluid expansion, synbiotics, vitamin K, and enteral nutrition for better surgical preparation.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Jaundiced patients undergoing liver resection for cholangiocarcinoma (CCA) often experience multiorgan dysfunction, impacting surgical outcomes.
- Optimizing preoperative management is crucial for improving postoperative prognosis in these complex cases.
Purpose of the Study:
- To review evidence-based medicine on preoperative treatments for hilar cholangiocarcinoma (CCA) patients before liver resection.
- To identify beneficial interventions for preparing jaundiced patients for surgery.
Main Methods:
- Electronic search of the Medline database.
- Identification of articles on preoperative treatments and their impact on jaundiced patients undergoing liver resection for CCA.
- Focus on renal dysfunction, bacterial translocation, hemostasis, malnutrition, liver failure, and outcomes.
Main Results:
- Grade B evidence supports extracellular water expansion and oral synbiotics.
- Intravenous vitamin K is effective.
- Grade A evidence recommends perioperative enteral nutrition for malnourished patients with compromised liver function undergoing extended resection.
- Grade C evidence suggests portal vein embolization for CCA when future remnant liver volume is <40%.
Conclusions:
- A simplified preoperative management scheme for obstructive jaundice is presented.
- Patient preparation remains a key determinant of postoperative prognosis, despite surgical advancements.
