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ENBD is Associated with Decreased Tumor Dissemination Compared to PTBD in Perihilar Cholangiocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Little is known regarding the risk of tumor dissemination when percutaneous biliary drainage is used before surgical resection of perihilar cholangiocarcinoma (PHC). We aimed to compare the incidence of tumor dissemination after preoperative endoscopic nasobiliary drainage (ENBD) with that after percutaneous transhepatic biliary drainage (PTBD) for PHC.

Methods

Data from 208 consecutive patients who underwent PHC resection between 2000 and 2013 were retrospectively analyzed. The influence of drainage type on incidence of tumor dissemination was examined. Seventy-six patients underwent ENBD (37%), 87 underwent PTBD (42%), and 45 underwent surgery without preoperative biliary drainage (WD, 22%).

Results

The respective 2- and 5-year estimated cumulative incidences of tumor dissemination in the ENBD group (11.8/14.6%) were lower than in the PTBD group (28.8/35.9%, p = 0.003) and equivalent to that in the WD group (11.2/15.9%, p = NS). PTBD (hazard ratio [HR] vs. ENBD, 2.80) was an independent risk factor for postoperative tumor dissemination in the multivariate analysis. The 2- and 5-year disease-specific survival rates were higher in the ENBD group (67.6/47.3%) than in the PTBD group (56.6/27.8%, p = 0.032) and equivalent to that in the WD group (64.9/53.8%, p = NS). However, drainage type was not an independent risk factor in multivariate analysis of disease-specific survival.

Conclusion

For patients with PHC, the associated risk of postoperative tumor dissemination in the ENBD group was lower than in the PTBD group and equivalent to that in the WD group. Thus, ENBD is the ideal procedure for preoperative biliary drainage.

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Abbreviations

PHC:

Perihilar cholangiocarcinoma

PTBD:

Percutaneous transhepatic biliary drainage

ENBD:

Endoscopic nasobiliary drainage

WD:

Without drainage

DSS:

Disease-specific survival

ICGR15 :

The ICG retention rate at 15 min

LTB:

The level of total bilirubin

AJCC:

American Joint Committee on Cancer

MST:

Median survival time

HR:

Hazard ratio

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Acknowledgements

The authors would like to thank Takehiro Ota, Kenichiro Imai, Hideki Kajiyama, and Mimi Okano at the Department of Surgery, Tokyo Women’s Medical University, who provided surgical assistance.

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Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Rohan Jagat Chaudhary & Masakazu Yamamoto

  2. Department of Pathology and International Research and Educational Institute for Integrated Medical Sciences, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Toru Furukawa

  3. Department of Histopathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan

    Toru Furukawa

Authors
  1. Ryota Higuchi
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  2. Takehisa Yazawa
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  4. Wataru Izumo
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  7. Masakazu Yamamoto
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Contributions

The conception and the design of the study: R.H.

The acquisition of data: R.H., T.Y., S.U., W.I., T.F., and M.Y.

Analysis and interpretation of data: R.H.

Pathological diagnosis: T.F.

Draft and critical analysis: R.H., R.C., T.F., and M.Y.

Corresponding author

Correspondence to Masakazu Yamamoto.

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Higuchi, R., Yazawa, T., Uemura, S. et al. ENBD is Associated with Decreased Tumor Dissemination Compared to PTBD in Perihilar Cholangiocarcinoma. J Gastrointest Surg 21, 1506–1514 (2017). https://doi.org/10.1007/s11605-017-3492-0

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  • DOI: https://doi.org/10.1007/s11605-017-3492-0

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