Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma

• Published in: Journal of gastroenterology 2016-06, Vol.51 (6), p.608-619
• Main Authors: Komaya, Kenichi, Ebata, Tomoki, Fukami, Yasuyuki, Sakamoto, Eiji, Miyake, Hideo, Takara, Daisuke, Wakai, Kenji, Nagino, Masato
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Biliary Tract; Cholangiocarcinoma - mortality; Cholangiocarcinoma - secondary; Cholangiocarcinoma - surgery; Colorectal Surgery; Drainage; Endoscopy; Female; Gastroenterology; Hepatology; Hospitals; Humans; Male; Medical colleges; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Seeding; Original Article—Liver; Pancreas; Pancreaticoduodenectomy; Propensity Score; Retrospective Studies; Surgical Oncology; Survival Rate; Treatment Outcome
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-015-1140-6

Background The aim of this study was to evaluate whether percutaneous transhepatic biliary drainage (PTBD) increases the incidence of seeding metastasis and shortens postoperative survival compared with endoscopic biliary drainage (EBD). Methods A total of 376 patients with distal cholangiocarcinoma who underwent pancreatoduodenectomy following either PTBD ( n  = 189) or EBD ( n  = 187) at 30 hospitals between 2001 and 2010 were retrospectively reviewed. Seeding metastasis was defined as peritoneal/pleural dissemination and PTBD sinus tract recurrence. Univariate and multivariate analyses followed by propensity score matching analysis were performed to adjust the data for the baseline characteristics between the two groups. Results The overall survival of the PTBD group was significantly shorter than that of the EBD group (34.2 % vs 48.8 % at 5 years; P  = 0.003); multivariate analysis showed that the type of biliary drainage was an independent predictor of survival ( P  = 0.036) and seeding metastasis ( P  = 0.001). After two new cohorts with 82 patients each has been generated after 1:1 propensity score matching, the overall survival rate in the PTBD group was significantly less than that in the EBD group (34.7 % vs 52.5 % at 5 years, P  = 0.017). The estimated recurrence rate of seeding metastasis was significantly higher in the PTBD group than in the EBD group (30.7 % vs 10.7 % at 5 years, P  = 0.006), whereas the recurrence rates at other sites were similar between the two groups ( P  = 0.579). Conclusions Compared with EBD, PTBD increases the incidence of seeding metastasis after resection for distal cholangiocarcinoma and shortens postoperative survival.