Controversy and strategy of preoperative biliary drainage reducing jaundice in hilar cholangiocarcinoma

The radical resection is the only curative way for hilar cholangiocarcinoma, and combined hepatectomy is usually needed to achieve the goal of radical resection. Most patients with hilar cholangiocarcinoma are accompanied by obstructive jaundice. Although preoperative biliary drainage (PBD) can improve liver function, blood coagulation function, nutritional status and immunologic function, control acute cholangitis and promote liver regeneration, but a series of its drawbacks currently lead to a big controversy about application value of radical resection of hilar cholangiocarcinoma. Through reviewing literatures and combining with clinical practice experiences, author suggested some ideas on effects, disadvantages, application value, indication and method selection of PBD that will provide a reference in clinical practices. Key words: Bile tract neoplasms, hilar; Radical resection; Biliary drainage, preoperative; Reducing jaundice; Percutaneous transhepatic cholangial drainage; Endoscopic biliary stent; Endoscopic nasobiliary drainage