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Outcome of patients with perihilar cholangiocarcinoma and previous biliary instrumentation: an observational study

Authors :
Karen T. Brown
Joanne F. Chou
Hannah B. Suchy
George I. Getrajdman
Mithat Gonen
Anne M. Covey
Lynn A. Brody
Mark A. Schattner
Michael I. D’Angelica
T. Peter Kingham
Joseph P. Erinjeri
William R. Jarnagin
Source :
BMC Gastroenterology, Vol 24, Iss 1, Pp 1-8 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

Abstract

Abstract Background To assess the outcome of previously untreated patients with perihilar cholangiocarcinoma who present to a cancer referral center with or without pre-existing trans-papillary biliary drainage. Methods Consecutive patients with a diagnosis of perihilar cholangiocarcinoma presenting between January 1, 2013, and December 31, 2017, were identified from a prospective surgical database and by a query of the institutional database. Of 237 patients identified, 106 met inclusion criteria and were reviewed. Clinical information was obtained from the Electronic Medical Record and imaging studies were reviewed in the Picture Archiving and Communication System. Results 73 of 106 patients (69%) presenting with a new diagnosis of perihilar cholangiocarcinoma underwent trans-papillary biliary drainage (65 endoscopic and 8 percutaneous) prior to presentation at our institution. 8 of the 73 patients with trans-papillary biliary drainage (11%) presented with and 5 developed cholangitis; all 13 (18%) required subsequent intervention; none of the patients without trans-papillary biliary drainage presented with or required drainage for cholangitis (p = 0.008). Requiring drainage for cholangitis was more likely to delay treatment (p = 0.012) and portended a poorer median overall survival (13.6 months, 95%CI [4.08, not reached)] vs. 20.6 months, 95%CI [18.34, 37.51] p = 0.043). Conclusion Trans-papillary biliary drainage for perihilar cholangiocarcinoma carries a risk of cholangitis and should be avoided when possible. Clinical and imaging findings of perihilar cholangiocarcinoma should prompt evaluation at a cancer referral center before any intervention. This would mitigate development of cholangitis necessitating additional drainage procedures, delaying treatment and potentially compromising survival.

Details

Language :
English
ISSN :
1471230X
Volume :
24
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Gastroenterology
Publication Type :
Academic Journal
Accession number :
edsdoj.f22cbb373cf8443282f4a67d2c271c71
Document Type :
article
Full Text :
https://doi.org/10.1186/s12876-024-03241-8