Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma

Autor: Anne-Marleen van Keulen, Marcia P. Gaspersz, Jeroen L.A. van Vugt, Eva Roos, Pim B. Olthof, Robert J.S. Coelen, Marco J. Bruno, Lydi M.J.W. van Driel, Rogier P. Voermans, Casper H.J. van Eijck, Jeanin E. van Hooft, Krijn P. van Lienden, Jeroen de Jonge, Wojciech G. Polak, Jan-Werner Poley, Chulja J. Pek, Adriaan Moelker, François E.J.A. Willemssen, Thomas M. van Gulik, Joris I. Erdmann, L. Hol, Jan N.M. IJzermans, Stefan Büttner, Bas Groot Koerkamp
Přispěvatelé: Gastroenterology and Hepatology, CCA - Cancer Treatment and Quality of Life, Amsterdam Gastroenterology Endocrinology Metabolism, Surgery, Anesthesiology, Graduate School, APH - Quality of Care, Pathology, Gastroenterology & Hepatology, Radiology & Nuclear Medicine
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Surgery (United States), 172(6), 1606-1613. Mosby Inc.
Keulen, A-M V, Gaspersz, M P, van Vugt, J L A, Roos, E, Olthof, P B, Coelen, R J S, Bruno, M J, van Driel, L M J W, Voermans, R P, van Eijck, C H J, van Hooft, J E, van Lienden, K P, de Jonge, J, Polak, W G, Poley, J-W, Pek, C J, Moelker, A, Willemssen, F E J A, van Gulik, T M, Erdmann, J I, Hol, L, IJzermans, J N M, Büttner, S & Koerkamp, B G 2022, ' Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma ', Surgery (United States), vol. 172, no. 6, pp. 1606-1613 . https://doi.org/10.1016/j.surg.2022.06.028
ISSN: 0039-6060
Popis: Background: The patients with unresectable perihilar cholangiocarcinoma require biliary drainage to relieve symptoms and allow for palliative systemic chemotherapy. The aim of this study was to establish the success, complication, and mortality rates of the initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma at presentation. Methods: In this retrospective multicenter study, patients with unresectable perihilar cholangiocarcinoma who underwent initial endoscopic or percutaneous transhepatic biliary drainage between 2002 and 2014 were included. The success of drainage was defined as a successful biliary stent or drain placement, no unscheduled reintervention within 14 days, and serum bilirubin levels 50% decrease in serum bilirubin after 14 days. Severe complications, and 90-day mortality were recorded. Results: Included were 186 patients: 161 (87%) underwent initial endoscopic biliary drainage and 25 (13%) underwent initial percutaneous transhepatic biliary drainage. The success of initial drainage was observed in 73 patients (45%) after endoscopic biliary drainage and 6 (24%) after percutaneous transhepatic biliary drainage. The reasons for an unsuccessful initial drainage were: the failure to place a drain or stent in 39 patients (21%), an unplanned reintervention within 14 days in 52 patients (28%), and the bilirubin level >50 μmol/L (or not halved) after 14 days of initial drainage in 16 patients (9%). Severe drainage-related complications occurred in 19 patients (12%) after endoscopic biliary drainage and in 3 (12%) after percutaneous transhepatic biliary drainage. Overall, 66 patients (36%) died within 90 days after initial biliary drainage. Conclusion: Initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma had a success rate of 45% and a 90-day mortality rate of 36%. Future studies for patients with perihilar cholangiocarcinoma should focus on improving biliary drainage.
Databáze: OpenAIRE
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