Research output: Contribution to journal › Article › Academic › peer-review
Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma. / Keulen, Anne-Marleen van; Gaspersz, Marcia P.; van Vugt, Jeroen L. A. et al.
In: Surgery (United States), Vol. 172, No. 6, 12.2022, p. 1606-1613.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Success, complication, and mortality rates of initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma
AU - Keulen, Anne-Marleen van
AU - Gaspersz, Marcia P.
AU - van Vugt, Jeroen L. A.
AU - Roos, Eva
AU - Olthof, Pim B.
AU - Coelen, Robert J. S.
AU - Bruno, Marco J.
AU - van Driel, Lydi M. J. W.
AU - Voermans, Rogier P.
AU - van Eijck, Casper H. J.
AU - van Hooft, Jeanin E.
AU - van Lienden, Krijn P.
AU - de Jonge, Jeroen
AU - Polak, Wojciech G.
AU - Poley, Jan-Werner
AU - Pek, Chulja J.
AU - Moelker, Adriaan
AU - Willemssen, François E. J. A.
AU - van Gulik, Thomas M.
AU - Erdmann, Joris I.
AU - Hol, L.
AU - IJzermans, Jan N. M.
AU - Büttner, Stefan
AU - Koerkamp, Bas Groot
N1 - Publisher Copyright: © 2022 The Author(s)
PY - 2022/12
Y1 - 2022/12
N2 - Background: The patients with unresectable perihilar cholangiocarcinoma require biliary drainage to relieve symptoms and allow for palliative systemic chemotherapy. The aim of this study was to establish the success, complication, and mortality rates of the initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma at presentation. Methods: In this retrospective multicenter study, patients with unresectable perihilar cholangiocarcinoma who underwent initial endoscopic or percutaneous transhepatic biliary drainage between 2002 and 2014 were included. The success of drainage was defined as a successful biliary stent or drain placement, no unscheduled reintervention within 14 days, and serum bilirubin levels <50 μmol/L (ie, 2.9 mg/dL) or a >50% decrease in serum bilirubin after 14 days. Severe complications, and 90-day mortality were recorded. Results: Included were 186 patients: 161 (87%) underwent initial endoscopic biliary drainage and 25 (13%) underwent initial percutaneous transhepatic biliary drainage. The success of initial drainage was observed in 73 patients (45%) after endoscopic biliary drainage and 6 (24%) after percutaneous transhepatic biliary drainage. The reasons for an unsuccessful initial drainage were: the failure to place a drain or stent in 39 patients (21%), an unplanned reintervention within 14 days in 52 patients (28%), and the bilirubin level >50 μmol/L (or not halved) after 14 days of initial drainage in 16 patients (9%). Severe drainage-related complications occurred in 19 patients (12%) after endoscopic biliary drainage and in 3 (12%) after percutaneous transhepatic biliary drainage. Overall, 66 patients (36%) died within 90 days after initial biliary drainage. Conclusion: Initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma had a success rate of 45% and a 90-day mortality rate of 36%. Future studies for patients with perihilar cholangiocarcinoma should focus on improving biliary drainage.
AB - Background: The patients with unresectable perihilar cholangiocarcinoma require biliary drainage to relieve symptoms and allow for palliative systemic chemotherapy. The aim of this study was to establish the success, complication, and mortality rates of the initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma at presentation. Methods: In this retrospective multicenter study, patients with unresectable perihilar cholangiocarcinoma who underwent initial endoscopic or percutaneous transhepatic biliary drainage between 2002 and 2014 were included. The success of drainage was defined as a successful biliary stent or drain placement, no unscheduled reintervention within 14 days, and serum bilirubin levels <50 μmol/L (ie, 2.9 mg/dL) or a >50% decrease in serum bilirubin after 14 days. Severe complications, and 90-day mortality were recorded. Results: Included were 186 patients: 161 (87%) underwent initial endoscopic biliary drainage and 25 (13%) underwent initial percutaneous transhepatic biliary drainage. The success of initial drainage was observed in 73 patients (45%) after endoscopic biliary drainage and 6 (24%) after percutaneous transhepatic biliary drainage. The reasons for an unsuccessful initial drainage were: the failure to place a drain or stent in 39 patients (21%), an unplanned reintervention within 14 days in 52 patients (28%), and the bilirubin level >50 μmol/L (or not halved) after 14 days of initial drainage in 16 patients (9%). Severe drainage-related complications occurred in 19 patients (12%) after endoscopic biliary drainage and in 3 (12%) after percutaneous transhepatic biliary drainage. Overall, 66 patients (36%) died within 90 days after initial biliary drainage. Conclusion: Initial biliary drainage in patients with unresectable perihilar cholangiocarcinoma had a success rate of 45% and a 90-day mortality rate of 36%. Future studies for patients with perihilar cholangiocarcinoma should focus on improving biliary drainage.
UR - http://www.scopus.com/inward/record.url?scp=85136111141&partnerID=8YFLogxK
U2 - 10.1016/j.surg.2022.06.028
DO - 10.1016/j.surg.2022.06.028
M3 - Article
C2 - 35989132
VL - 172
SP - 1606
EP - 1613
JO - Surgery
JF - Surgery
SN - 0039-6060
IS - 6
ER -
ID: 25832133