Outcome of patients with perihilar cholangiocarcinoma and previous biliary instrumentation: An observational study Journal Article


Authors: Brown, K. T.; Chou, J. F.; Suchy, H. B.; Getrajdman, G. I.; Gonen, M.; Covey, A. M.; Brody, L. A.; Schattner, M. A.; D’Angelica, M. I.; Kingham, T. P.; Erinjeri, J. P.; Jarnagin, W. R.
Article Title: Outcome of patients with perihilar cholangiocarcinoma and previous biliary instrumentation: An observational study
Abstract: Background: To assess the outcome of previously untreated patients with perihilar cholangiocarcinoma who present to a cancer referral center with or without pre-existing trans-papillary biliary drainage. Methods: Consecutive patients with a diagnosis of perihilar cholangiocarcinoma presenting between January 1, 2013, and December 31, 2017, were identified from a prospective surgical database and by a query of the institutional database. Of 237 patients identified, 106 met inclusion criteria and were reviewed. Clinical information was obtained from the Electronic Medical Record and imaging studies were reviewed in the Picture Archiving and Communication System. Results: 73 of 106 patients (69%) presenting with a new diagnosis of perihilar cholangiocarcinoma underwent trans-papillary biliary drainage (65 endoscopic and 8 percutaneous) prior to presentation at our institution. 8 of the 73 patients with trans-papillary biliary drainage (11%) presented with and 5 developed cholangitis; all 13 (18%) required subsequent intervention; none of the patients without trans-papillary biliary drainage presented with or required drainage for cholangitis (p = 0.008). Requiring drainage for cholangitis was more likely to delay treatment (p = 0.012) and portended a poorer median overall survival (13.6 months, 95%CI [4.08, not reached)] vs. 20.6 months, 95%CI [18.34, 37.51] p = 0.043). Conclusion: Trans-papillary biliary drainage for perihilar cholangiocarcinoma carries a risk of cholangitis and should be avoided when possible. Clinical and imaging findings of perihilar cholangiocarcinoma should prompt evaluation at a cancer referral center before any intervention. This would mitigate development of cholangitis necessitating additional drainage procedures, delaying treatment and potentially compromising survival. © The Author(s) 2024.
Keywords: adult; cancer chemotherapy; clinical article; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; cancer surgery; retrospective studies; major clinical study; overall survival; mortality; cancer radiotherapy; outcome assessment; computer assisted tomography; retrospective study; pruritus; bilirubin; electronic medical record; medical information; surgery; jaundice; bile duct neoplasms; hyperbilirubinemia; observational study; biliary tract drainage; logistic regression analysis; univariate analysis; endoscopy; bilirubin blood level; leukocyte; rank sum test; drainage; klatskin tumor; bile duct cancer; endoscopic retrograde cholangiopancreatography; bile duct tumor; diagnostic test accuracy study; demographics; magnetic resonance cholangiopancreatography; cholangitis; very elderly; biliary stent; humans; human; male; female; article; artificial embolization; leukocyte culture; endoscopic stent; peri-hilar cholangiocarcinoma; tibial plateau
Journal Title: BMC Gastroenterology
Volume: 24
ISSN: 1471-230X
Publisher: Biomed Central Ltd  
Date Published: 2024-05-24
Start Page: 181
Language: English
DOI: 10.1186/s12876-024-03241-8
PUBMED: 38783208
PROVIDER: scopus
PMCID: PMC11118511
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- Source: Scopus
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MSK Authors
  1. Joanne Fu-Lou Chou
    331 Chou
  2. Mithat Gonen
    1029 Gonen
  3. Anne Covey
    165 Covey
  4. William R Jarnagin
    903 Jarnagin
  5. T Peter Kingham
    609 Kingham
  6. Lynn Brody
    119 Brody
  7. Joseph Patrick Erinjeri
    202 Erinjeri
  8. Mark Schattner
    169 Schattner