Abstract
Background
Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA). The goal of this retrospective study was to identify the preferred technique of PBD for HCA.
Methods
A total of 128 consecutive patients with HCA diagnosed between September 1999 and December 2009 who underwent PBD were included in this study. The study compared outcomes of endoscopic nasobiliary drainage (ENBD), endoscopic biliary stenting (EBS), and percutaneous transhepatic biliary drainage (PTBD) in patients with HCA.
Results
There were no significant differences in preoperative laboratory data, rates of major hepatectomy, or decompression periods among the 3 groups. Complications were significantly more frequent in the EBS group compared with either the ENBD or PTBD group (p < 0.05). Drainage tube occlusion with cholangitis was significantly more common in the EBS group compared with either the ENBD or PTBD group (p < 0.0001). Patients in the PTBD group experienced serious complications including vascular injury (8%) and cancer dissemination (4%). Patients in the ENBD and EBS groups had mild post-endoscopic retrograde cholangiopancreatography pancreatitis (5%). Conversion procedures were significantly more common in the EBS group compared with the ENBD and PTBD groups (p < 0.05). There was no significant difference in postsurgical morbidity or mortality among the 3 groups.
Conclusions
Drainage tube occlusion with cholangitis was a frequent complication associated with EBS. PTBD was associated with serious complications such as vascular injury and cancer dissemination. ENBD was found to be the most suitable method for initial PBD management in patients with HCA.
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Abbreviations
- PTBD:
-
Percutaneous transhepatic biliary drainage
- PBD:
-
Preoperative biliary drainage
- ENBD:
-
Endoscopic nasobiliary drainage
- EBS:
-
Endoscopic biliary stenting
- ERCP:
-
Endoscopic retrograde cholangiopancreatography
- ICG:
-
Indocyanine green
- EBD:
-
Endoscopic biliary drainage
- EST:
-
Endoscopic sphincterotomy
- HCA:
-
Hilar cholangiocarcinoma
References
Maguchi H, Takahashi K, Katanuma A, Osanai M, Nakahara K, Matuzaki S, et al. Preoperative biliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2007;14:441–6.
Arakura N, Takayama M, Ozaki Y, Maruyama M, Chou Y, Kodama R, et al. Efficacy of preoperative endoscopic nasobiliary drainage for hilar cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2009;16:473–7.
Kloek JJ, van der Gaag NA, Aziz Y, Rauws EA, van Delden OM, Lameris JS, et al. Endoscopic and percutaneous preoperative biliary drainage in patients with suspected hilar cholangiocarcinoma. J Gastrointest Surg. 2010;14:119–25.
Nagino M, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Kondo S, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008;15:25–30.
Kawakami H, Kuwatani M, Etoh K, Haba S, Yamato H, Shinada K, et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy. 2009;41:959–64.
Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg. 1992;215:31–8.
Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, et al. Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg. 2004;240:95–101.
Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, et al. Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Surg. 2009 [Epub ahead of print].
Cotton PB, Lehman G, Vennes J, Geenen JE, Russell RC, Meyers WC, et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991;37:383–93.
Nagino M, Nimura Y, Hayakawa N, Kamiya J, Kondo S, Sasaki R, et al. Logistic regression and discriminant analyses of hepatic failure after liver resection for carcinoma of the biliary tract. World J Surg. 1993;17:250–5.
Kanai M, Nimura Y, Kamiya J, Kondo S, Nagino M, Miyachi M, et al. Preoperative intrahepatic segmental cholangitis in patients with advanced carcinoma involving the hepatic hilus. Surgery. 1996;119:498–504.
Sakata J, Shirai Y, Tsuchiya Y, Wakai T, Nomura T, Hatakeyama K. Preoperative cholangitis independently increases in-hospital mortality after combined major hepatic and bile duct resection for hilar cholangiocarcinoma. Langenbecks Arch Surg. 2009;394:1065–72.
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Kawakami, H., Kuwatani, M., Onodera, M. et al. Endoscopic nasobiliary drainage is the most suitable preoperative biliary drainage method in the management of patients with hilar cholangiocarcinoma. J Gastroenterol 46, 242–248 (2011). https://doi.org/10.1007/s00535-010-0298-1
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DOI: https://doi.org/10.1007/s00535-010-0298-1