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Digestive Diseases and Sciences

, Volume 64, Issue 2, pp 561–569 | Cite as

Biliary Decompression in Perihilar Cholangiocarcinoma Improves Survival: A Single-Center Retrospective Analysis

  • Lisa S. CassaniEmail author
  • Jay Chouhan
  • Christopher Chan
  • Gandhi Lanke
  • Hsiang-Chun Chen
  • Xuemei Wang
  • Brian Weston
  • William A. Ross
  • Gottumukkala S. Raju
  • Jeffrey H. Lee
Original Article

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.

Keywords

Biliary drainage Endoscopic retrograde cholangiopancreatography Self-expanding metal stent Cholangiocarcinoma Cholangitis Klatskin tumor 

Abbreviations

CS

Clinical success

ERCP

Endoscopic retrograde cholangiopancreatography

Fr

French

HR

Hazard ratio

OR

Odds ratio

OS

Overall survival

PS

Plastic stent

PTC

Percutaneous transhepatic cholangiography

SEMS

Self-expanding metal stent

TS

Technical success

Notes

Author’s contribution

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.

Supplementary material

10620_2018_5277_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Lisa S. Cassani
    • 1
    • 2
    • 3
    Email author
  • Jay Chouhan
    • 1
  • Christopher Chan
    • 1
  • Gandhi Lanke
    • 1
  • Hsiang-Chun Chen
    • 4
  • Xuemei Wang
    • 4
  • Brian Weston
    • 1
  • William A. Ross
    • 1
  • Gottumukkala S. Raju
    • 1
  • Jeffrey H. Lee
    • 1
  1. 1.Gastroenterology, Hepatology, and NutritionThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Division of Digestive Diseases, Department of MedicineEmory University School of MedicineAtlantaUSA
  3. 3.Division of Digestive Diseases, Department of MedicineAtlanta Veterans Affairs Medical CenterDecaturUSA
  4. 4.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA

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