Endoscopic or percutaneous biliary drainage for Klatskin tumors? A large retrospective study.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 277-277
Author(s):  
Thomas Walter ◽  
Chia Ho ◽  
Anne M. Horgan ◽  
Andrew Warkentin ◽  
Steven Gallinger ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Total Bilirubin ◽  
Klatskin Tumor ◽  
Biliary Decompression ◽  
Therapeutic Success ◽  
Kaplan Meier ◽  
Decompression Procedure ◽  
Klatskin Tumors ◽  
Transhepatic Biliary Drainage ◽  
Large Retrospective Study

277 Background: Controversy exists over the preferred technique of biliary drainage in patients with Klatskin tumors as few comparative studies exist. This study compared outcomes of endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD). Methods: 129 patients with Klatskin tumors with an initial EBD or PTBD were identified from 01/01/1991 to 31/05/2011 and their clinical histories were retrospectively reviewed. The primary end point was the time to therapeutic success (TTS: time between the first drainage and a total bilirubin<40µmol/L), estimated by Kaplan-Meier analysis. Results: The first biliary decompression procedure was EBD in 87 patients and PTBD in 42 patients. The technical (98% vs 78%, p=0.004) and therapeutic (79% vs 49%, p=0.002) successes were significantly higher in the PTBD group than EBD group, respectively; Forty four patients (51%) in the EBD group subsequently underwent a PTBD before achieving therapeutic success or starting their antitumoral treatment. The median TTS was 55 days in EBD group vs 44 days in the PTBD group (multivariate analysis: HR=0.63, 95% CI=0.41-0.99, p=0.045). In patients treated by surgery or chemotherapy +/− radiotherapy, the median time to treatment was 68 and 76 days in the PTBD group and the EBD group, respectively, p=0.76. 25% and 21% of cholangitis occurred in EBD and PTBD group, respectively (p=0.34). Conclusions: In the era where chemotherapy prolongs life even in advanced disease, shortening time to success matters. Our results suggest relying on PTB for biliary decompression would be an improved treatment strategy when treating patients with Klatskin tumor.

Impact on gemcitabine plus cisplatin in unresectable hilar cholangiocarcinoma patients according to effective biliary drainage: A multicenter study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15658-e15658
Author(s):  
Jingu Kang ◽  
Jong-Chan Lee ◽  
Min Jae Kim ◽  
Se Yeol Yang ◽  
Sang Myung Woo ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Hilar Cholangiocarcinoma ◽  
Total Bilirubin ◽  
Survival Curve ◽  
Best Supportive Care ◽  
Rank Test ◽  
Chemotherapeutic Regimen ◽  
Kaplan Meier ◽  
Referral Hospitals ◽  
The Impact

e15658 Background: Hilar cholangiocarcinoma (HC) is known to have a poor prognosis due to cholangitis and lack of effective chemotherapeutic regimen. Since 2010, gemcitabine plus cisplatin (GP) is recommended as first-line chemotherapy in cholangiocarcinoma. However, it is still unclear whether GP is effective on HC. We aimed to evaluate the impact on GP in unresectable HC patients according to effective biliary drainage (EBD). Methods: From 2010 to 2016, 112 patients with unresectable HC confirmed by biopsy at three tertiary referral hospitals in Korea were enrolled. 38 patients received GP [cisplatin (25 mg per square meter of body-surface area) followed by gemcitabine (1000 mg per square meter), each administered on days 1 and 8, every 3 weeks]. 74 patients received best supportive care (BSC). The EBD group was defined as a total bilirubin decrease of less than 2 mg/dl within 2 weeks after the first drainage procedure or 50% reduction than pre-procedure total bilirubin. Overall survival (OS) was evaluated in GP group and BSC group according to EBD achieved using the Kaplan–Meier survival curve and the log-rank test. Results: When compared with the BSC group (n = 74), the GP group (n = 38) obtained a benefit in OS (median OS, 6.14 vs 12.7 months, p < 0.001). Moreover, patients with EBD experienced significantly longer OS compared with ineffective biliary drainage (IEBD) patients (median OS, 8.03 vs 5.01 months, p < 0.005). GP chemotherapy was beneficial for OS in IEBD group (p < 0.001) as well as in EBD group (p < 0.005). In the multivariate analysis, GP chemotherapy (HR 0.33, 95% CI 0.21–0.52, p < 0.001), EBD (HR 0.60, 95% CI 0.40–0.91, p < 0.001) and 2 more metastatic site (HR 3.21, 95% CI 1.66–6.18, p < 0.001) were significant prognostic factors. Conclusions: GP chemotherapy provides longer survival in HC, regardless of effective or ineffective biliary drainage.

scholarly journals Therapy for hilar cholangiocarcinoma

2019 ◽  
Vol 18 (1) ◽  
pp. 103-115 ◽  
Author(s):  
D. Yu. Frantsev ◽  
O. N. Sergeeva ◽  
B. I. Dolgushin
Keyword(s):  
Hilar Cholangiocarcinoma ◽  
Biliary Stricture ◽  
Klatskin Tumor ◽  
Biliary Decompression ◽  
Tumor Patients ◽  
Dismal Prognosis ◽  
Significant Prolongation ◽  
Tumor Material ◽  
Late Metastasis ◽  
Transhepatic Biliary Drainage

Purpose: to present different modalities of biliary decompression and specific antitumor treatment of hilar cholangiocarcinoma (Klatkin tumor). material and methods. The review was based on 318 publications available from Pubmed, Medline, Elibrary, etc. in the interval time between 19212018. results. Hilar cholangiocarcinoma is a rare hepatobiliary malignancy with dismal prognosis demonstrating slow periductal infiltrative growth, late metastasis and causing death mainly due to local complications. Percutaneous transhepatic biliary drainage (PTBD) is the optimal way of biliary decompression for malignant hilar strictures nowadays. PTBD is the safest, technically accessible technique with reproducible results. Transpapillary decompression in Klatskin tumor patients is technically feasible in 40 % of cases only. Biliary resection accompanied by major hepatectomy is considered the only curative modality to the date, but its results aren’t satisfactory a well as the majority of patients aren’t seemed the surgical candidates. Thus the locoregional technologies, i.e. radiation therapy, radiofrequency ablation and photodynamic therapy (PDT), are widely spread. PDT should be preferred over other local modalities due to safety, efficiency, possibility of reinterventions, technical and economic accessibility. conclusion. Modern approaches to the management of Klatskin tumor do not differ much from the those proposed by the first researchers in the middle of the xxth century and comes down to the biliary stricture dilatation and the sustenance of the normal bile passage as long as possible. However, despite the strategic stagnation, significant tactical successes were achieved thus allowing significant prolongation of survival in previously considered incurable patients.

scholarly journals Dynamic change of serum CA19–9 levels in benign and malignant patients with obstructive jaundice after biliary drainage and new correction formulas

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bangbo Zhao ◽  
Qin Cheng ◽  
Hongtao Cao ◽  
Xingtong Zhou ◽  
Tianhao Li ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Clinical Characteristics ◽  
Total Bilirubin ◽  
Dynamic Change ◽  
Clinical Decision ◽  
Diagnostic Value ◽  
Biliary Decompression ◽  
Correction Formula ◽  
Change Trend

Abstract Background CA19–9 is one of the most widely used tumor markers in biliary-pancreatic diseases. The measured value may not factually reflect the genuine CA19–9 level secreted by tumor, which affected by biliary obstruction. There is an urgent need of developing a correction formula of CA19–9 in biliary obstructive patients to guide clinical practice and avoid making improper clinical decision. Methods Clinical characteristics were collected among patients undergoing biliary drainage in our hospital between January 2014 and January 2019. By comparing the malignant and benign patients statistically, dynamic change trend of CA19–9 levels after biliary drainage was obtained. The correction formulas of CA19–9 were generated by means of linear regression. Results 121 patients, including 102 malignant and 19 benign patients, were enrolled in this study. The baseline CA19–9 level of malignant patients is much higher than that of benign patients. Total bilirubin (TB) level was found to be not related with CA19–9 value (p = 0.109). The drop proportion of the average CA19–9 level in the malignant patients (39.2%, IQR -18.4-78.6%) was much lower than that in the benign patients (75.7%, IQR 58.1–86.6%) (p = 0.014). The correction formula, CA19–9True = 0.63 × CA19–9Measured - 20.3 (R2 = 0.693, p<0.001), was generated based on the linear relation between CA19–9 after drainage and CA19–9 before drainage in malignant patients, which had similar diagnostic value with true CA19–9 value. Conclusions Quantitative correction formulas of CA19–9 considering the effect of biliary decompression was first proposed in this study, aiming to provide a more accurate CA19–9 level to make more accurate clinical decision and avoid making improper therapeutic schedule.

Hyperalimentation of jaundiced patients on percutaneous transhepatic biliary drainage

1986 ◽  
Vol 73 (9) ◽  
pp. 716-719 ◽  
Author(s):  
D. Foschi ◽  
G. Cavagna ◽  
F. Callioni ◽  
E. Morandi ◽  
V. Rovati
Keyword(s):  
Biliary Drainage ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Transhepatic Biliary Drainage

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

2016 ◽  
Vol 101 (1-2) ◽  
pp. 78-83 ◽  
Author(s):  
Ki-Han Kim ◽  
Ho-Byoung Lee ◽  
Sung-Heun Kim ◽  
Min-Chan Kim ◽  
Ghap-Joong Jung
Keyword(s):  
Biliary Drainage ◽  
Percutaneous Transhepatic Biliary Drainage ◽  
Duodenal Stump ◽  
Surgical Interventions ◽  
Afferent Loop Syndrome ◽  
Soft Diet ◽  
Bile Drainage ◽  
Duodenal Stump Leakage ◽  
Transhepatic Biliary Drainage

The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.

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