Zhang Xu-Feng, Beal Eliza W, Merath Katiuscha, Ethun Cecilia G, Salem Ahmed, Weber Sharon M, Tran Thuy, Poultsides George, Son Andre Y, Hatzaras Ioannis, Jin Linda, Fields Ryan C, Weiss Matthew, Scoggins Charles, Martin Robert C G, Isom Chelsea A, Idrees Kamron, Mogal Harveshp D, Shen Perry, Maithel Shishir K, Schmidt Carl R, Pawlik Timothy M
Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Surg Oncol. 2018 May;117(6):1267-1277. doi: 10.1002/jso.24945. Epub 2017 Dec 4.
The objective of the current study was to define long-term survival of patients with resectable hilar cholangiocarcinoma (HCCA) after preoperative percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD).
Between 2000 and 2014, 240 patients who underwent curative-intent resection for HCCA were identified at 10 major hepatobiliary centers. Postoperative morbidity and mortality, as well as disease-specific survival (DSS) and recurrence-free survival (RFS) were analyzed among patients.
The median decrease in total bilirubin levels after biliary drainage was similar comparing PTBD (n = 104) versus EBD (n = 92) (mg/dL, 4.9 vs 4.9, P = 0.589) before surgery. There was no difference in baseline demographic characteristics, type of surgical procedure performed, final AJCC tumor stage or postoperative morbidity among patients who underwent EBD only versus PTBD (all P > 0.05). Patients who underwent PTBD versus EBD had a comparable long-term DSS (median, 43.7 vs 36.9 months, P = 0.802) and RFS (median, 26.7 vs 24.0 months, P = 0.571). The overall pattern of recurrence relative to regional or distant disease was also the same among patients undergoing PTBD and EBD (P = 0.669) CONCLUSIONS: Oncologic outcomes including DSS and RFS were similar among patients who underwent PTBD versus EBD with no difference in tumor recurrence location.
本研究的目的是明确可切除肝门部胆管癌（HCCA）患者术前经皮经肝胆道引流（PTBD）与内镜下胆道引流（EBD）后的长期生存率。
2000年至2014年期间，在10个主要肝胆中心确定了240例行根治性切除的HCCA患者。分析了患者的术后发病率和死亡率，以及疾病特异性生存率（DSS）和无复发生存率（RFS）。
术前胆道引流后总胆红素水平的中位数下降在PTBD组（n = 104）和EBD组（n = 92）中相似（mg/dL，4.9对4.9，P = 0.589）。仅接受EBD与PTBD的患者在基线人口统计学特征、所进行的手术类型、最终AJCC肿瘤分期或术后发病率方面无差异（所有P>0.05）。接受PTBD与EBD的患者具有相当的长期DSS（中位数，43.7对36.9个月，P = 0.802）和RFS（中位数，26.7对24.0个月，P = 0.571）。PTBD和EBD患者中相对于局部或远处疾病的总体复发模式也相同（P = 0.669）。结论：接受PTBD与EBD的患者在包括DSS和RFS在内的肿瘤学结局相似，肿瘤复发部位无差异。
