Efficacy of preoperative endoscopic nasobiliary drainage tube placement for liver cancer adjacent to the hepatic hilum.

PURPOSE

Surgical resection of liver cancer adjacent to the hepatic hilum is challenging, especially in balancing remnant liver volume preservation with bile duct safety. This study evaluated the efficacy of preoperative endoscopic nasobiliary drainage (ENBD) tube placement as an intraoperative guide for bile duct preservation during liver resection.

METHODS

Sixteen patients with liver cancer adjacent to the hepatic hilum who underwent preoperative ENBD tube placement and curative liver resection from 2016 to 2023 were retrospectively reviewed. Liver resection was performed along the bile duct where the ENBD tube was placed, preserving that bile ducts and liver section. Risks associated with ENBD tube insertion, the short-term outcomes, and local recurrence incidence were assessed.

RESULTS

The ENBD tube was placed a median 3 days preoperatively in the right lobe in 12 patients and the left lobe in four. No patient experienced post-endoscopic retrograde cholangiopancreatography pancreatitis, and all patients underwent surgery as scheduled. Surgeons could preserve the bile ducts nearby the tumor by directly palpating the ENBD tube and/or using air cholangiography in all cases. Clinically relevant bile leakage occurred in one patient (6.3%). The median time to discharge was 12 days, with no significant posthepatectomy liver failure and mortality. All patients achieved negative surgical margins, and only one patient experienced local recurrence (6.3%).

CONCLUSION

Preoperative ENBD tube placement is a safe, collaborative endoscopic-surgical technique that facilitates optimal liver preservation and acceptable local control for liver cancer adjacent to the hepatic hilum.