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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

Open Access 01-12-2015 | Hepatobiliary Tumors

Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases

Authors: Jimme K. Wiggers, MD, Bas Groot Koerkamp, MD, PhD, Robert J. Coelen, MD, Alexandre Doussot, MD, Susan van Dieren, PhD, Erik A. Rauws, MD, PhD, Mark A. Schattner, MD, Krijn P. van Lienden, MD, PhD, Karen T. Brown, MD, Marc G. Besselink, MD, PhD, Geert van Tienhoven, MD, PhD, Peter J. Allen, MD, Olivier R. Busch, MD, PhD, Michael I. D’Angelica, MD, Ronald P. DeMatteo, MD, Dirk J. Gouma, MD, PhD, T. Peter Kingham, MD, Joanne Verheij, MD, PhD, William R. Jarnagin, MD, Thomas M. van Gulik, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Background

Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) are both used to resolve jaundice before surgery for perihilar cholangiocarcinoma (PHC). PTBD has been associated with seeding metastases. The aim of this study was to compare overall survival (OS) and the incidence of initial seeding metastases that potentially influence survival in patients with preoperative PTBD versus EBD.

Methods

Between 1991 and 2012, a total of 278 patients underwent preoperative biliary drainage and resection of PHC at 2 institutions in the Netherlands and the United States. Of these, 33 patients were excluded for postoperative mortality. Among the 245 included patients, 88 patients who underwent preoperative PTBD (with or without previous EBD) were compared to 157 patients who underwent EBD only. Survival analysis was done with Kaplan–Meier and Cox regression with propensity score adjustment.

Results

Unadjusted median OS was comparable between the PTBD group (35 months) and EBD-only group (41 months; P = 0.26). After adjustment for propensity score, OS between the PTBD group and EBD-only group was similar (hazard ratio, 1.05; 95 % confidence interval, 0.74–1.49; P = 0.80). Seeding metastases in the laparotomy scar occurred as initial recurrence in 7 patients, including 3 patients (3.4 %) in the PTBD group and 4 patients (2.7 %) in the EBD-only group (P = 0.71). No patient had an initial recurrence in percutaneous catheter tracts.

Conclusions

The present study found no effect of PTBD on survival compared to patients with EBD and no increase in seeding metastases that developed as initial recurrence. These data suggest that PTBD can safely be used in preoperative management of PHC.
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Metadata
Title
Percutaneous Preoperative Biliary Drainage for Resectable Perihilar Cholangiocarcinoma: No Association with Survival and No Increase in Seeding Metastases
Authors
Jimme K. Wiggers, MD
Bas Groot Koerkamp, MD, PhD
Robert J. Coelen, MD
Alexandre Doussot, MD
Susan van Dieren, PhD
Erik A. Rauws, MD, PhD
Mark A. Schattner, MD
Krijn P. van Lienden, MD, PhD
Karen T. Brown, MD
Marc G. Besselink, MD, PhD
Geert van Tienhoven, MD, PhD
Peter J. Allen, MD
Olivier R. Busch, MD, PhD
Michael I. D’Angelica, MD
Ronald P. DeMatteo, MD
Dirk J. Gouma, MD, PhD
T. Peter Kingham, MD
Joanne Verheij, MD, PhD
William R. Jarnagin, MD
Thomas M. van Gulik, MD, PhD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4676-z

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