Biliary drainage in palliative and curative intent European patients with hilar cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis.

Autor: Drews J; Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany., Baar LC; Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany., Schmeisl T; Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany., Bunde T; Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany.; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany., Stang A; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany.; Department of Oncology and Palliative Care, Asklepios Hospital Barmbek, Hamburg, Germany., Reese T; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany.; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany., Wagner KC; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany.; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany., Oldhafer KJ; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany.; Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Asklepios Hospital Barmbek, Hamburg, Germany., von Hahn T; Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Ruebenkamp 220, 22307, Hamburg, Germany. t.hahn@asklepios.com.; Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany. t.hahn@asklepios.com.; Asklepios Tumorzentrum Hamburg, Hamburg, Germany. t.hahn@asklepios.com.
Jazyk: angličtina
Zdroj: BMC gastroenterology [BMC Gastroenterol] 2024 Oct 10; Vol. 24 (1), pp. 359. Date of Electronic Publication: 2024 Oct 10.
DOI: 10.1186/s12876-024-03429-y
Abstrakt: Background and Aims: Relief of cholestasis in hilar cholangiocarcinoma is commonly undertaken in both curative and palliative treatment plans. There are numerous open questions with regard to the ideal biliary drainage strategy - including what constitutes clinical success (CS). In the existing data, curative patients and patients from the Western world are underrepresented.
Patients and Methods: We performed a retrospective analysis of patients with complex malignant hilar obstruction (Bismuth-Corlette II and higher) due to cholangiocarcinoma who underwent biliary drainage at a German referral center between 2010 and 2020. We aimed to define CS and complication rates and directly compare outcomes in curative and palliative patients.
Results: 56 curative and 72 palliative patients underwent biliary drainage. In patients with curative intent, CS was achieved significantly more often regardless of what definition of CS was applied (e.g., total serum bilirubin (TSB) < 2 mg/dl: 66.1% vs. 27.8%, p = < 0.001, > 75% reduction of TSB: 57.1% vs. 29.2%, p = 0.003). This observation held true only when subgroups with the same Bismuth-Corlette stage were compared. Moreover, palliative patients experienced a significantly greater percentage of adverse events (33.3% vs. 12.5%, p = 0.01). Curative intent treatment and TSB at presentation were predictive factors of CS regardless of what definition of CS was applied. The observed CS rates are comparable to published studies involving curative patients, but inferior to reported CS rates in palliative series mostly from Asia.
Conclusions: Biliary drainage in complex malignant hilar obstruction due to cholangiocarcinoma is more likely to be successful and less likely to cause adverse events in curative patients compared to palliative patients.
(© 2024. The Author(s).)
Databáze: MEDLINE
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