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ENBD is Associated with Decreased Tumor Dissemination Compared to PTBD in Perihilar Cholangiocarcinoma
- Source :
- Journal of Gastrointestinal Surgery. 21:1506-1514
- Publication Year :
- 2017
- Publisher :
- Springer Science and Business Media LLC, 2017.
-
Abstract
- Little is known regarding the risk of tumor dissemination when percutaneous biliary drainage is used before surgical resection of perihilar cholangiocarcinoma (PHC). We aimed to compare the incidence of tumor dissemination after preoperative endoscopic nasobiliary drainage (ENBD) with that after percutaneous transhepatic biliary drainage (PTBD) for PHC. Data from 208 consecutive patients who underwent PHC resection between 2000 and 2013 were retrospectively analyzed. The influence of drainage type on incidence of tumor dissemination was examined. Seventy-six patients underwent ENBD (37%), 87 underwent PTBD (42%), and 45 underwent surgery without preoperative biliary drainage (WD, 22%). The respective 2- and 5-year estimated cumulative incidences of tumor dissemination in the ENBD group (11.8/14.6%) were lower than in the PTBD group (28.8/35.9%, p = 0.003) and equivalent to that in the WD group (11.2/15.9%, p = NS). PTBD (hazard ratio [HR] vs. ENBD, 2.80) was an independent risk factor for postoperative tumor dissemination in the multivariate analysis. The 2- and 5-year disease-specific survival rates were higher in the ENBD group (67.6/47.3%) than in the PTBD group (56.6/27.8%, p = 0.032) and equivalent to that in the WD group (64.9/53.8%, p = NS). However, drainage type was not an independent risk factor in multivariate analysis of disease-specific survival. For patients with PHC, the associated risk of postoperative tumor dissemination in the ENBD group was lower than in the PTBD group and equivalent to that in the WD group. Thus, ENBD is the ideal procedure for preoperative biliary drainage.
- Subjects :
- Male
medicine.medical_specialty
Percutaneous
medicine.medical_treatment
030230 surgery
Bile duct cancer
Resection
03 medical and health sciences
0302 clinical medicine
Risk Factors
Preoperative Care
medicine
Humans
Endoscopy, Digestive System
Perihilar Cholangiocarcinoma
Risk factor
Aged
Retrospective Studies
business.industry
Incidence (epidemiology)
Hazard ratio
Gastroenterology
medicine.disease
Survival Rate
Bile Duct Neoplasms
030220 oncology & carcinogenesis
Drainage
Female
Surgery
Radiology
Hepatectomy
business
Klatskin Tumor
Subjects
Details
- ISSN :
- 18734626 and 1091255X
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Journal of Gastrointestinal Surgery
- Accession number :
- edsair.doi.dedup.....662ed9193dab8467bf23a0931535e468