Debulking surgery for non-radically resectable intraductal papillary neoplasm of the bile duct: Three case reports and literature review

Table 1 Clinical information

Variable	Case 1	Case 2	Case 3
Age/sex	64/male	69/female	76/female
Chief complaint	Abdominal pain, jaundice	Jaundice	Incidental biliary dilatation
Relevant history	Schistosomiasis, ERCP	Schistosomiasis, cholecystectomy, CBDE	Cholecystectomy, CBDE
Pre-op TBIL (μmol/L)	207.1	41.8 (peaked 167.3)	41.1
CA19-9 (U/mL)	126.5	Normal	> 1000
Pre-op biliary drainage	ENBD, PTCD (left)	PTCD (bilateral)	None
Dominant lobe involved	Left lateral, right posterior	Left lateral, right posterior	Left lobe
Debulking procedure	Open left lateral sectionectomy	Lap. left lateral sectionectomy	Lap left hepatectomy
SRLVR of curative plan	N/A	29.5%	33.4%
SRLVR of post-debulking	N/A	72.5%	90.5%
Pathologic diagnosis	Type 1 IPNB, margin+	Type 1 IPNB with HGD, margin+	IPNB with invasive carcinoma
Follow-up duration	7 years	2 years	7 months (alive)
Outcome	Died from liver failure	Died from biliary hemorrhage	Alive with residual tumor

TBIL: Total bilirubin; ERCP: Endoscopic retrograde cholangiopancreatography; CBDE: Common bile duct exploration; PTCD: Percutaneous transhepatic cholangial drainage; Lap: Laparoscopic; SRLVR: Standardized residual liver volume ratio; ENBD: Endoscopic nasobiliary drainage; IPNB: Intraductal papillary neoplasm of the bile; HGD: High-grade dysplasia; CA19-9: Carbohydrate antigen; N/A: Not applicable.