Department of Radiology, New York-Presbyterian Hospital, New York, NY, USA.
Weil Medical College of Cornell University, New York, NY, USA.
BMC Gastroenterol. 2024 May 24;24(1):181. doi: 10.1186/s12876-024-03241-8.
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.
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.
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).
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.
评估先前未经治疗的肝门部胆管癌患者在癌症转诊中心就诊时是否存在或不存在经乳头胆道引流的情况。
从一个前瞻性手术数据库和机构数据库查询中确定了 2013 年 1 月 1 日至 2017 年 12 月 31 日期间诊断为肝门部胆管癌的连续患者。在 237 例患者中，有 106 例符合纳入标准并进行了回顾。临床信息来自电子病历，影像学研究在图片存档和通信系统中进行了回顾。
在我们机构就诊时，106 例新诊断的肝门部胆管癌患者中有 73 例（69%）接受了经乳头胆道引流（65 例内镜下和 8 例经皮）。在接受经乳头胆道引流的 73 例患者中，有 8 例（11%）出现了胆管炎，5 例出现了胆管炎；所有 13 例（18%）需要进一步干预；没有接受经乳头胆道引流的患者没有出现或需要进行胆管炎引流（p=0.008）。需要引流胆管炎的患者更有可能延迟治疗（p=0.012），中位总生存期也更差（13.6 个月，95%CI [4.08，未达到）vs. 20.6 个月，95%CI [18.34，37.51]，p=0.043）。
肝门部胆管癌经乳头胆道引流有发生胆管炎的风险，应尽可能避免。肝门部胆管癌的临床和影像学表现应在任何干预之前在癌症转诊中心进行评估。这将减少需要额外引流程序的胆管炎的发生，延迟治疗并可能危及生存。
