Biliary Decompression in Perihilar Cholangiocarcinoma Improves Survival: A Single-Center Retrospective Analysis
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.
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.
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.
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.
KeywordsBiliary drainage Endoscopic retrograde cholangiopancreatography Self-expanding metal stent Cholangiocarcinoma Cholangitis Klatskin tumor
Endoscopic retrograde cholangiopancreatography
Percutaneous transhepatic cholangiography
Self-expanding metal stent
LC was involved in conception and design, data collection and interpretation, drafting and revision of manuscript; JC collected and interpreted the data; CC collected the data; GL collected and interpreted the data; H-CC analyzed and interpreted the data, and revised the manuscript; XW was involved in data analysis and interpretation, revision of manuscript; BW interpreted the data and revised the manuscript; WR interpreted the data and revised the manuscript; GR interpreted the data and revised the manuscript; JL was involved in conception and design, data interpretation, revision of manuscript.
Compliance with ethical standards
Conflict of interest
No authors have any disclosures to report.
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