Impact of preoperative percutaneous transhepatic biliary drainage on post‐operative survival in patients with distal cholangiocarcinoma

Abstract

Background: The aim of this study was to investigate the long-term impact of the type of preoperative biliary drainage used for patients undergoing pancreatoduodenectomy for distal cholangiocarcinoma (DCC). Methods: A total of 84 patients with DCC who underwent preoperative biliary drainage between June 2000 and December 2016 were divided into groups for whom percutaneous transhepatic biliary drainage (PTBD) (n = 24) or endoscopic biliary drainage (EBD) (n = 60) was used. Results: The 5-year overall survival in the PTBD group was significantly worse than that in the EBD group (16.7% versus 52.3%, P = 0.007). After propensity score matching (22 patients in each group), the 5-year overall survival in the PTBD group was still worse than that in the EBD group (13.6% versus 61.2%, P = 0.003). Multivariate analysis revealed that PTBD was independent risk factor for both poor survival (P = 0.028) and peritoneal recurrence (P = 0.018). The incidence of multiple sites at initial recurrence tended to be higher in the PTBD group than in the EBD group (P = 0.080). Conclusions: PTBD should not be performed for patients undergoing pancreatoduodenectomy for DCC, except when EBD is contraindicated, as PTBD is significantly associated with shorter survival and peritoneal recurrence.

Adverse oncologic effects of preoperative biliary drainage on early stage ampulla of Vater cancer

“…PBD for other types of biliary and periampullary malignancies has a negative effect on oncologic outcomes. 5,26 For pancreatic cancers located anatomically near the AoV, the need for a so-called "notouch isolation technique" has been discussed. 27 Recently, as part of minimally invasive treatment for early stage AoV cancer, many endoscopists have undergone endoscopic papillectomy with promising results.…”

An overview of extrahepatic cholangiocarcinoma: from here to where?

“…Interestingly, nerve fiber density invaded by tumors could be related to unfavorable outcomes of pCCA patients undergoing curative-intent surgery (47). Regarding preoperative evaluation, preoperative biliary drainage is still debated but needed when obstructive symptoms are present for eCCA patients whereas endoscopic biliary drainage seems to be more suitable for dCCA than percutaneous transhepatic biliary drainage which had lower rates of complications for pCCA (48)(49)(50). Moreover, laboratory assessment on peripheral blood revealed that neutrophil count, fibrinogen-to-lymphocyte ratio (FLR), and FLR-neutrophil score could predict the prognosis of patients with resected eCCA (51).…”

Surgical Treatment of Distal Cholangiocarcinoma

“…EBD is typically utilized for dCCA, as the transpapillary approach allows for better access to the tumor site. Although somewhat debated, indications for drainage include relief of obstructive jaundice, bilirubin greater than 10 mg/dL and palliative relief in patients who are not surgical candidates [ 28 , 29 , 30 ]. However, a critical complication to consider is severe cholangitis, which can occur secondary to the introduction of bacteria from the gastrointestinal tract after instrumentation of the biliary tree.…”