Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial

Coelen, R.J.; Roos, Eva; Wiggers, Jimme K.; Besselink, Marc G.; Buis, Carlijn I.; Busch, Olivier R.; Dejong, Cornelis H. C.; Delden, Otto M. van; Eijck, Casper H.J. van; Fockens, Paul; Gouma, Dirk J.; Koerkamp, Bas Groot; Haan, Michiel W. de; Hooft, Jeanin E. van; IJzermans, Jan N.M.; Kater, G. Matthijs; Koornstra, Jan J.; Lienden, Krijn P. van; Moelker, Adriaan; Damink, Steven W. M. Olde; Poley, Jan–Werner; Porte, Robert J.; Ridder, Rogier J. De; Verheij, Joanne; Woerden, Victor van; Rauws, Erik A.; Dijkgraaf, Marcel G. W.; Gulik, Thomas M. van

doi:10.1016/s2468-1253(18)30234-6

Cited by 151 publications

(116 citation statements)

References 34 publications

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“…A recent RCT comparing PTBD to EBD was stopped for excess mortality in the PTBD group (41% vs 11%), whereas severe preoperative drainage‐related complications were comparable in the two populations. However, the sample size of this study was small (27 patients per arm) …”

Section: Perihilar Cholangiocarcinomamentioning

confidence: 94%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

250

224

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Surgical resection is the only potentially curative treatment for patients with cholangiocarcinoma. For both perihilar cholangiocarcinoma (pCCA) and intrahepatic cholangiocarcinoma (iCCA), 5‐year overall survival of about 30% has been reported in large series. This review addresses several challenges in surgical management of cholangiocarcinoma. The first challenge is diagnosis: a biopsy is typically avoided because of the risk of seeding metastases and the low yield of a brush of the bile duct. However, about 15% of patients with suspected pCCA are found to have a benign diagnosis after resection. The second challenge is staging; even with the best preoperative imaging, a substantial percentage of patients has occult metastatic disease detected at staging laparoscopy or early recurrence after resection. The third challenge is an adequate volume and function of the future liver remnant, which may require preoperative biliary drainage and portal vein embolization. The fourth challenge is a complete resection: a positive bile duct margin is not uncommon because the microscopic biliary extent of disease may be more extensive than perceived on imaging. The fifth challenge is the high post‐operative mortality that has decreased in very high volume Asian centres, but remains about 10% in many Western referral centres. The sixth challenge is that even after a complete resection most patients develop recurrent disease. Recent randomized controlled trials found conflicting results regarding the benefit of adjuvant chemotherapy. The final challenge is to determine which patients with cholangiocarcinoma should undergo liver transplantation rather than resection.

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Section: Perihilar Cholangiocarcinomamentioning

confidence: 94%

Surgery for cholangiocarcinoma

Cillo

Fondevila

Donadon

et al. 2019

Liver International

250

224

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“…Definitive conclusions about the approach to biliary drainage would likely require a randomized clinical trial with a high accrual and retention. Next, our study was unable to identify if a drainage procedure was performed at a high‐volume or low‐volume center, an important metric that may influence the outcomes, especially considering the high complications rates shown in the DRAINAGE trial . In addition, we were also unable to examine types of stents used in these procedures or rates of stent exchange.…”

Section: Discussionmentioning

confidence: 97%

“…For patients that do eventually proceed to hepatectomy, preoperative biliary drainage has been shown to reduce the risk of mortality and incidence of postoperative hepatic failure . While biliary drainage offers benefits, technique‐related complications, and infections in this high‐risk patient population portend significant morbidity and mortality and thus the choice of approach is of substantial importance . The primary goal of our study was to examine the relationship between the occurrence of infectious complications and violation (vs preservation) of the sphincter of Oddi, regardless of the PTBD or EBD technique used.…”

Section: Discussionmentioning

confidence: 99%

“…The only randomized controlled clinical trial to compare PTBD and EBD in patients with cholangiocarcinoma reported an increased rate of cholangitis and intraabdominal abscess after EBD, although this difference was not statistically significant. The trial was terminated prematurely due to increased all‐cause mortality in the PTBD group . While these previous studies have focused mainly on technical approach, consideration specifically of violating the Sphincter of Oddi and the resultant contamination of the biliary tree remains undefined.…”

Section: Introductionmentioning

confidence: 99%

“…The trial was terminated prematurely due to increased allcause mortality in the PTBD group. 6 While these previous studies have focused mainly on technical approach, consideration specifically of violating the Sphincter of Oddi and the resultant contamination of the biliary tree remains undefined.…”

mentioning

confidence: 99%

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Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Kariya

Wach

Ruff

et al. 2019

Journal of Surgical Oncology

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Background The optimal approach to biliary drainage for patients with supra‐ampullary cholangiocarcinoma remains undetermined. Violation of sphincter of Oddi results in bacterial colonization of bile ducts and may increase postdrainage infectious complications. We sought to determine if rates of cholangitis are affected by the type of drainage procedure. Methods We examined the Surveillance, Epidemiology, and End Results‐Medicare linked database from 1991 to 2013 for cholangiocarcinoma. Biliary drainage procedures were categorized as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP). Patients were stratified by resection. Results A total of 1914 patients were included in the final analysis. A total of 1264 patients did not undergo a postdrainage resection (SOP 83, SOV 1181) while 650 did undergo a postdrainage resection (SOP 26, SOV 624). For those patients not undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was 19% compared with 34% in the SOV cohort (P = 0.007). For those patients undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was less than 42.3% compared with 30% in the SOV cohort (P = 0.66). Conclusion For patients with supra‐ampullary cholangiocarcinoma that did not undergo resection, biliary drainage procedures that violated the sphincter of Oddi were associated with increased rates of cholangitis.

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Essential updates to the surgical treatment of biliary tract cancer

Matsukuma

Tokumitsu

Shindo

et al. 2019

Annals of Gastroent Surgery

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Biliary tract cancer, which includes intrahepatic cholangiocarcinoma, extrahepatic bile duct cancer, gallbladder cancer, and ampullary cancer, is an intractable disease with a dismal prognosis. Prognosis is particularly poor in cases involving vessels or lymph nodes. Hepatobiliary pancreatic surgeons worldwide have consistently focused on improving surgical treatment, perioperative management, and chemotherapy to improve the outcomes of these diseases. There has been significant progress even in the last 2 years (2017 and 2018), such as promising findings reported by studies on the optimal extent of surgical treatment and multi‐institutional randomized controlled trials on adjuvant chemotherapy. We overview the current trends and advancements made in surgical treatment in 2017 and 2018.

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Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial

Cited by 151 publications

References 34 publications

Surgery for cholangiocarcinoma

Surgery for cholangiocarcinoma

Postbiliary drainage rates of cholangitis are impacted by procedural technique for patients with supra‐ampullary cholangiocarcinoma: A SEER‐Medicare analysis

Essential updates to the surgical treatment of biliary tract cancer

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