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Biliary Decompression in Perihilar Cholangiocarcinoma Improves Survival: A Single-Center Retrospective Analysis.
Cassani, Lisa S; Chouhan, Jay; Chan, Christopher; Lanke, Gandhi; Chen, Hsiang-Chun; Wang, Xuemei; Weston, Brian; Ross, William A; Raju, Gottumukkala S; Lee, Jeffrey H.
Afiliação
  • Cassani LS; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. lisa.cassani@emory.edu.
  • Chouhan J; Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. lisa.cassani@emory.edu.
  • Chan C; Division of Digestive Diseases, Department of Medicine, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA. lisa.cassani@emory.edu.
  • Lanke G; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Chen HC; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Wang X; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Weston B; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Ross WA; Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Raju GS; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
  • Lee JH; Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Dig Dis Sci ; 64(2): 561-569, 2019 02.
Article em En | MEDLINE | ID: mdl-30238201
ABSTRACT
BACKGROUND AND

AIMS:

The complex biliary strictures of perihilar cholangiocarcinoma present significant challenges for providing adequate and long-lasting biliary drainage. The best approach to relieve obstruction remains controversial. The purpose of this study was to assess stenting outcomes in perihilar cholangiocarcinoma.

METHODS:

This study was approved by the center's institutional review board. Subjects with a diagnosis of perihilar cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography (ERCP) were identified from endoscopic and pathologic databases from 1997 to 2014. Patient characteristics, endoscopic data, and follow-up evaluation data were retrospectively collected via review of available medical records.

RESULTS:

A total of 199 patients with perihilar cholangiocarcinoma who underwent a total of 504 ERCPs were included in the study. Nine of 504 (1.8%) procedures were technical failures. Among the 495 technically successful procedures, 347 (70.1%) procedures were clinical successes. Clinical success was significantly associated with longer overall survival (HR 0.57; p = 0.002). A higher proportion of patients with bilateral drainage had clinical success, compared with those with unilateral drainage. Cholangitis was not more common in the bilateral group compared to the unilateral group except in the group where a segment was not drained (1.9% vs 1.6% vs 7.1%, respectively). Patients with metal stents were 3.8 times more likely to have clinical success than those with plastic stents.

CONCLUSIONS:

In conclusion, adequate biliary drainage improves overall survival. Bilateral stenting if anatomy permits with self-expanding metal stents rather than plastic stents appears to provide the optimal chance of clinical success.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias dos Ductos Biliares / Drenagem / Colestase / Colangiopancreatografia Retrógrada Endoscópica / Tumor de Klatskin / Descompressão Cirúrgica Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Dig Dis Sci Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias dos Ductos Biliares / Drenagem / Colestase / Colangiopancreatografia Retrógrada Endoscópica / Tumor de Klatskin / Descompressão Cirúrgica Tipo de estudo: Etiology_studies / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Dig Dis Sci Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos