Selection of drainage method for resectable cholangiocarcinoma complicated by obstructive jaundice

OBJECTIVE

To compare the results of percutaneous and endoscopic biliary decompression for resectable perihilar tumor (PT).

MATERIAL AND METHODS

Treatment outcomes were analyzed in patients with PT who underwent surgery between 1999 and 2023. The 1^st group included patients who underwent percutaneous transhepatic cholangiostomy as the first stage for biliary decompression, the 2^nd group — patients who underwent endoscopic biliary drainage.

RESULTS

There were 58 patients with percutaneous transhepatic cholangiostomy and 18 ones with endoscopic biliary drainage. Both groups were comparable in main parameters. There were patients with isolated resection of extrahepatic bile ducts in the group of percutaneous transhepatic cholangiostomy, but these were absent in the 2^nd group (p=0.328). Extended right-sided hemihepatectomies were more common in the 1^st group (29.3% versus 11.1%, p=0.210). Post-manipulation complications grade ≥ III degree more common after endoscopic biliary drainage (50.0% versus 22.4%, p=0.037), and percutaneous cholangiostomy was also more common to correct complications (44.4% versus 10.3%, p=0.003). There was no difference in the rate of post-resection complications grade ≥III (p=0.787) and postoperative mortality (p=0.721). There was also no difference in peritoneal metastases (p=1.0) and implantation metastases (p=1.0). In addition, we found no worsening of long-term results after percutaneous transhepatic cholangiostomy. The median overall survival in this group was 25 months versus 15 months after endoscopic biliary drainage (p=0.740). There was also no difference in disease-free survival (p=0.500).

CONCLUSION

Percutaneous transhepatic cholangiostomy as the primary method for obstructive jaundice in patients with resectable PT is accompanied by better immediate results of biliary decompression without worsening the results of resection.