Long-term outcome in patients with advanced hilar bile duct tumors undergoing palliative endoscopic or percutaneous drainage

Born, Peter; Rösch, Thomas; Brühl, K.; Sandschin, W; Weigert, N.; Ott, Raffael; Frimberger, E; Allescher, H. D.; Hoffmann, Werner; Neuhaus, Horst; Classen, Meinhard

doi:10.1055/s-2000-14886

Cited by 49 publications

(40 citation statements)

References 11 publications

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“…However, the infection However, the infection was successfully controlled with antibiotics in this study. The current study showed a similar rate of cholangitis in the �RBD and PTBD�� groups and a different retrospective review of 59 patients with unresectable Klatskin's tumor tumor umor showed that endoscopically placed stents caused fewer acute complications than percutaneously placed stents (11% vs 33%) [13] . In this study, adequate initial relief of jaundice was achieved in 91% of the patients.…”

Section: Discussionsupporting

confidence: 68%

“…Advances in interventional radiology and therapeutic endoscopy have facilitated nonsurgical management for patients with advanced types of the disease as well as those with high operative risks [10][11][12] . �ndoscopic or percutaneous �ndoscopic or percutaneous drainage has therefore become established as effective and relatively noninvasive alternatives for palliation of jaundice [13] . Currently, endoscopic retrograde biliary drainage Currently, endoscopic retrograde biliary drainage (�RBD), e�ternal percutaneous transhepatic biliary drainage e�ternal percutaneous transhepatic biliary drainage percutaneous transhepatic biliary drainage (�PTBD), and internal biliary stenting �PTBD), and internal biliary stenting PTBD), and internal biliary stenting via the PTBD tract (IPTBD) are being used for the palliation of jaundice in IPTBD) are being used for the palliation of jaundice in PTBD) are being used for the palliation of jaundice in patients with unresectable Klatskin's tumor.…”

Section: Introductionmentioning

confidence: 99%

“…umor. Only one study compared the complication rate associated with �RBD and �PTBD in a small number of patients �PTBD in a small number of patients PTBD in a small number of patients [13] . Therefore, we conducted a study to evaluate the efficacy of the drainage procedures �RBD, �PTBD, and IPTBD �PTBD, and IPTBD PTBD, and IPTBD IPTBD PTBD based on the Bismuth type in patients with inoperable Klatskin's tumor.…”

Section: Introductionmentioning

confidence: 99%

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Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

Lee

Park

Yoon³

et al. 2007

WJG

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AIM: To investigate differences in the effects of biliary drainage procedures in patients with inoperable Klatskin's tumor based on Bismuth type, considering endoscopic retrograde biliary drainage (ERBD), external percutaneous transhepatic biliary drainage (EPTBD) and internal biliary stenting via the PTBD tract (IPTBD). METHODS:The initial success rate, cumulative patency rate, and complication rate were compared retrospectively, according to the Bismuth type and ERBD, EPTBD, and IPTBD. Patency was defined as the duration for adequate initial bile drainage or to the point of the patient's death associated with inadequate drainage. RESULTS:One hundred thirty-four patients (93 men, 41 women; 21 Bismuth type Ⅱ, 47 Ⅲ, 66 Ⅳ; 34 ERBD, 66 EPTBD, 34 IPTBD) were recruited. There were no differences in demographics among the groups. Adequate initial relief of jaundice was achieved in 91% of patients without a significant difference in the results among different procedures or Bismuth types. The cumulative patency rates for ERBD and IPTBD were better than those for EPTBD with Bismuth type Ⅲ. IPTBD provided an excellent response for Bismuth type Ⅳ. However, there was no difference in the patency rate among drainage procedures for Bismuth type Ⅱ. Procedure-related cholangitis occurred less frequently with EPTBD than with ERBD and IPTBD.CONCLUSION: ERBD is recommended as the firstline drainage procedure for the palliation of jaundice in patients with inoperable Klatskin's tumor of Bismuth type Ⅱ or Ⅲ, but IPTBD is the best option for Bismuth type Ⅳ.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

Lee

Park

Yoon³

et al. 2007

WJG

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“…Possible treatment strategies for best supportive care include endoscopic retrograde cholangiography (ERC) with transpapillary stent therapy or percutaneous transhepatic biliary drainage (PTBD) [6][7][8] . Effective endoscopic stent placement provides adequate relief of symptoms associated with biliary obstruction and leads to increased overall survival [9,10] . Systemic chemotherapy, another palliative therapy concept, is marginally effective and doselimited because of toxic side effects [11] .…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

Weber

Landrock²,

Schneider³

et al. 2007

WJG

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AIM:To evaluate the long-term outcome and prognostic factors of patients with hilar cholangiocarinoma. METHODS:Ninety-six consecutive patients underwent treatment for malignant hilar bile duct tumors during [1995][1996][1997][1998][1999][2000][2001][2002][2003][2004][2005]. Of the 96 patients, 20 were initially treated with surgery (n = 2 R0 / n = 18 R1). In non-operated patients, data analysis was performed retrospectively. RESULTS:Among the 96 patients, 76 were treated with endoscopic transpapillary (ERC, n = 45) and/or percutaneous transhepatic biliary drainage (PTBD, n = 31). The mean survival time of these 76 patients undergoing palliative endoscopic and/or percutaneous drainage was 359 ± 296 d. The mean survival time of patients with initial bilirubin levels > 10 mg/dL was significantly lower (P < 0.001) than patients with bilirubin levels < 10 mg/dL. The mean survival time of patients with Bismuth stage Ⅱ (n = 8), Ⅲ (n = 28) and Ⅳ (n = 40) was 496 ± 300 d, 441 ± 385 d and 274 ± 218 d, respectively. Thus, patients with advanced Bismuth stage showed a reduced mean survival time, but the difference was not significant. The type of biliary drainage had no significant beneficial effect on the mean survival time (ERC vs PTBD, P = 0.806). CONCLUSION:Initial bilirubin level is a significant prognostic factor for survival of patients. In contrast, age, tumor stage according to the Bismuth-Corlette classification, and types of intervention are not significant prognostic parameters for survival. Palliative treatment with endoscopic or percutaneous biliary drainage is still suboptimal, new diagnostic and therapeutic tools need to be evaluated.

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“…However, for Type Ⅲ tumors, radical resection is an aggressive procedure that might involve removal of the left or right hepatic lobe and caudate lobe of the liver. A mortality rate of up to 10% has been encountered, and survival after surgical resection on this type of tumor has been disappointing [12,14,[21][22][23][24] . Palliative resection of Type Ⅳ tumor is still controversial, but doctors tend to perform liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation as a treatment for hilar cholangiocarcinoma

Fan

Liang³

et al. 2008

WJG

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AIM:To explore the role of radio-frequency ablation (RFA) as a treatment for hilar cholangiocarcinoma. M E T H O D S :E l e v e n p a t i e n t s w i t h o b s t r u c t i v e cholestasis underwent Computed Tomography (CT) examination, occupying lesions were observed in the hepatic hilar region in each patient. All lesions were confirmed as cholangioadenocarcinoma by biopsy and were classified as type Ⅲ or Ⅳ by percutaneous transhepatic cholangiography. Patients were treated with multiple electrodes RFA combined with other adjuvant therapy. The survival rate, change of CT attenuation coefficient of the tumor and tumor size were studied in these patients after RFA. RESULTS: In a follow-up CT scan one month after RFA, a size reduction of about 30% was observed in six masses, and two masses were reduced by about 20% in size, three of the eleven masses remained unchanged. In a follow-up CT scan 6 mo after RFA, all the masses were reduced in size (overall 35%), in which the most significant size reduction was 60%. The survival follow-up among these eleven cases was 18 mo in average. Ongoing follow-up showed that the longest survival case was 30 mo and the shortest case was 10 mo. CONCLUSION: RFA is a microinvasive and effective treatment for hilar cholangiocarcinoma.

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Long-term outcome in patients with advanced hilar bile duct tumors undergoing palliative endoscopic or percutaneous drainage

Cited by 49 publications

References 11 publications

Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type

Long-term outcome and prognostic factors of patients with hilar cholangiocarcinoma

Radiofrequency ablation as a treatment for hilar cholangiocarcinoma

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