Xu-Feng Zhang1,2, Eliza W Beal2, Katiuscha Merath2, Cecilia G Ethun3, Ahmed Salem4, Sharon M Weber4, Thuy Tran5, George Poultsides5, Andre Y Son6, Ioannis Hatzaras6, Linda Jin7, Ryan C Fields7, Matthew Weiss8, Charles Scoggins9, Robert C G Martin9, Chelsea A Isom10, Kamron Idrees10, Harveshp D Mogal11, Perry Shen11, Shishir K Maithel3, Carl R Schmidt2, Timothy M Pawlik2. 1. Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China. 2. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio. 3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia. 4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 5. Department of Surgery, Stanford University Medical Center, Stanford, California. 6. Department of Surgery, New York University, New York, New York. 7. Department of Surgery, Washington University School of Medicine, St Louis, Missouri. 8. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. 9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky. 10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 11. Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
Abstract
BACKGROUND AND OBJECTIVES: The objective of the current study was to define long-term survival of patients with resectable hilar cholangiocarcinoma (HCCA) after preoperative percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD). METHODS: Between 2000 and 2014, 240 patients who underwent curative-intent resection for HCCA were identified at 10 major hepatobiliary centers. Postoperative morbidity and mortality, as well as disease-specific survival (DSS) and recurrence-free survival (RFS) were analyzed among patients. RESULTS: The median decrease in total bilirubin levels after biliary drainage was similar comparing PTBD (n = 104) versus EBD (n = 92) (mg/dL, 4.9 vs 4.9, P = 0.589) before surgery. There was no difference in baseline demographic characteristics, type of surgical procedure performed, final AJCC tumor stage or postoperative morbidity among patients who underwent EBD only versus PTBD (all P > 0.05). Patients who underwent PTBD versus EBD had a comparable long-term DSS (median, 43.7 vs 36.9 months, P = 0.802) and RFS (median, 26.7 vs 24.0 months, P = 0.571). The overall pattern of recurrence relative to regional or distant disease was also the same among patients undergoing PTBD and EBD (P = 0.669) CONCLUSIONS: Oncologic outcomes including DSS and RFS were similar among patients who underwent PTBD versus EBD with no difference in tumor recurrence location.
BACKGROUND AND OBJECTIVES: The objective of the current study was to define long-term survival of patients with resectable hilar cholangiocarcinoma (HCCA) after preoperative percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD). METHODS: Between 2000 and 2014, 240 patients who underwent curative-intent resection for HCCA were identified at 10 major hepatobiliary centers. Postoperative morbidity and mortality, as well as disease-specific survival (DSS) and recurrence-free survival (RFS) were analyzed among patients. RESULTS: The median decrease in total bilirubin levels after biliary drainage was similar comparing PTBD (n = 104) versus EBD (n = 92) (mg/dL, 4.9 vs 4.9, P = 0.589) before surgery. There was no difference in baseline demographic characteristics, type of surgical procedure performed, final AJCC tumor stage or postoperative morbidity among patients who underwent EBD only versus PTBD (all P > 0.05). Patients who underwent PTBD versus EBD had a comparable long-term DSS (median, 43.7 vs 36.9 months, P = 0.802) and RFS (median, 26.7 vs 24.0 months, P = 0.571). The overall pattern of recurrence relative to regional or distant disease was also the same among patients undergoing PTBD and EBD (P = 0.669) CONCLUSIONS: Oncologic outcomes including DSS and RFS were similar among patients who underwent PTBD versus EBD with no difference in tumor recurrence location.
Authors: S O'Brien; N Bhutiani; M E Egger; A N Brown; K H Weaver; D Kline; L R Kelly; C R Scoggins; R C G Martin; G C Vitale Journal: Surg Endosc Date: 2019-05-28 Impact factor: 4.584