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

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
Hepatobiliary Tumors
Volume 22, Issue 3 / December , 2015

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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