Peripheral hepatojejunostomy as palliative treatment for irresectable malignant tumors of the liver hilum

Objective To evaluate the concept of surgical decompression of the biliary tree by pe ripheral hepatojejunostomy for palliative treatment of jaundice in patients with irresectable malignant tumors of the liver hilum. Summary Background Data Jaundice, pruritus, and recurrent cholangitis are major clinical complicati ons in patients with obstructive cholestasis resulting from malignant tumor s of the liver hilum. Methods for palliative treatment include endoscopic s tenting, percutaneous transhepatic drainage, and surgical decompression. Th e palliative treatment of choice should be safe, effective, and comfortable for the patient. Methods In a retrospective study, surgical technique, perioperative complications, and efficacy of treatment were analyzed for 56 patients who had received a peripheral hepatojejunostomy between 1982 and 1997. Laparotomy in all of th ese patients had been performed as an attempt for curative resection. Results Hepatojejunostomy was exclusively palliative in 50 patients and was used fo r bridging to resection or transplantation in 7. Anastomosis was bilateral in 36 patients and unilateral in 20. The I-month mortality in the study gro up was 9%; median survival was 6 months. In patients surviving >1 month, a marked and persistent decrease in cholestasis was achieved in 87%, although complete return to normal was rare. Among the patients with a marked decre ase in cholestasis, 72% had no or only mild clinical symptoms such as fever or jaundice. Conclusions Peripheral hepatojejunostomy is a feasible and reasonably effective palliat ive treatment for patients with irresectable tumors of the liver hilum. In patients undergoing exploratory laparotomy for attempted curative resection , this procedure frequently leads to persistent-although rarely complete-de compression of the biliary tree. In a few cases it may also be used for bri dging to transplantation or liver resection after relief of cholestasis.