Effectiveness and safety of preoperative percutaneous transhepatic cholangiodrainage with bile re-infusion in patients with hilar cholangiocarcinoma: a retrospective controlled study

• Published in: The American journal of the medical sciences Vol. 346; no. 5; p. 353
• Main Authors: Yu, Fu-Xiang, Ji, Shi-Qiang, Su, Long-Feng, Zhang, Sheng-Chu, Zhang, Qi-Yu
• Format: Journal Article
• Language: English
• Published: United States 01.11.2013
• Subjects: Bile; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - surgery; Bile Ducts, Intrahepatic; Cholangiocarcinoma - mortality; Cholangiocarcinoma - surgery; Digestive System Surgical Procedures; Drainage - adverse effects; Drainage - methods; Female; Humans; Male; Middle Aged; Palliative Care; Preoperative Care - adverse effects; Preoperative Care - methods; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; Treatment Outcome
• ISSN: 1538-2990
• DOI: 10.1097/MAJ.0b013e3182755de6

Extensive controversies exist over the use of preoperative biliary drainage preceding radical resection of hilar cholangiocarcinoma. This study assessed the effectiveness and safety of percutaneous transhepatic cholangiodrainage (PTCD) with bile re-infusion in the preoperative optimization of hilar cholangiocarcinoma patients. Eligible hilar cholangiocarcinoma patients received preoperative PTCD with bile re-infusion (treatment group, n = 56) through a nasoduodenal tube for 2 weeks, and the control group (n = 60) received conservative treatment alone. Operable patients were assigned to undergo either a radical or palliative resection. The outcome measures included the overall resection rate, R0 resection rate, surgical morbidity rate and 1-year and 5-year overall survival rates. The treatment group exhibited a significant decrease in serum bilirubin levels after PTCD with bile re-infusion. The overall resection rate was significantly higher in the treatment group than in the control group (85.5% vs. 65.0%, P < 0.05), and the palliative resection rate was also significantly higher in the treatment group (53.5% vs. 35.0%, P < 0.05). However, the R0 resection rate was comparable between the 2 groups (32.1% vs. 30.0%, P > 0.05). The morbidity rate was significantly lower in the treatment group than in the control group (29.1% vs. 51.3%, P < 0.05). One-year and 5-year survival rates were similar between the 2 groups (69.6% vs. 66.7%, P > 0.05; 5.3% vs. 3.6%, P > 0.05). Preoperative PTCD with bile re-infusion improves the resection rate and shows a good safety profile in patients with hilar cholangiocarcinoma.