Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma: No association with survival and no increase in seeding metastases Journal Article

   

Authors:	Wiggers, J. K.; Groot Koerkamp, B.; Coelen, R. J.; Doussot, A.; van Dieren, S.; Rauws, E. A.; Schattner, M. A.; van Lienden, K. P.; Brown, K. T.; Besselink, M. G.; van Tienhoven, G.; Allen, P. J.; Busch, O. R.; D'Angelica, M. I.; DeMatteo, R. P.; Gouma, D. J.; Kingham, T. P.; Verheij, J.; Jarnagin, W. R.; Van Gulik, T. M.
Article Title:	Percutaneous preoperative biliary drainage for resectable perihilar cholangiocarcinoma: No association with survival and no increase in seeding metastases
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. © 2015, The Author(s).
Keywords:	adult; cancer survival; controlled study; aged; middle aged; cancer surgery; major clinical study; overall survival; cancer recurrence; united states; follow up; cancer incidence; netherlands; preoperative period; surgical mortality; intermethod comparison; bile duct carcinoma; percutaneous drainage; tumor seeding; propensity score; human; male; female; article; percutaneous transhepatic drainage; perihilar cholangiocarcinoma; endoscopic biliary drainage; percutaneous transhepatic biliary drainage
Journal Title:	Annals of Surgical Oncology
Volume:	22
Issue:	Suppl. 3
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2015-12-01
Start Page:	1156
End Page:	1163
Language:	English
DOI:	10.1245/s10434-015-4676-z
PROVIDER:	scopus
PMCID:	PMC4686560
PUBMED:	26122370
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84952871405&partnerID=40&md5=27a3090dad89ea76e3a86c027534a9fa
Notes:	Article -- Export Date: 3 February 2016 -- Source: Scopus

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