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

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

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.

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Acknowledgments

The following investigators of the Nagoya Surgical Oncology Group also participated in this study: T. Aoba (Toyohashi Municipal Hospital), Y. Kaneoka (Ogaki Municipal Hospital), T. Arai (Anjo Kosei Hospital), Y. Shimizu (Aichi Cancer Center Hospital), K. Shirai (Yamashita Hospital), S. Ohira (Handa City Hospital), Y. Tojima (Social Insurance Chukyo Hospital), N. Morofuji (The Gifu Prefectural Federation of Agricultural Cooperatives for Health and Welfare Kumiai Hospital), A. Akutagawa (Nagoya Ekisaikai Hospital), R. Yamaguchi (Kasugai Municipal Hospital), T. Kawahara (Daido Hospital), S. Mizuno (Shizuoka Kosei Hospital), N. Matsumoto (Hekinan Municipal Hospital), S. Ota (Kani Tono Hospital), M. Takano (Asahi Rousai Hospital), H. Yamamoto (Tokai Hospital), M. Inoue (Tokoname City Hospital), Y. Asaba (Enshu Hospital), T. Watanabe (Chita City Hospital), M. Hashimoto (Chubu Rosai Hospital), S. Kawai (Tsushima City Hospital), K. Ikuta (Tokai Municipal Hospital), H. Matsubara (Yachiyo Hospital), and S. Kondo (Sakashita Hospital).

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Kenichi Komaya, Tomoki Ebata & Masato Nagino

  2. Department of Surgery, Toyota Kosei Hospital, Toyota, Japan

    Yasuyuki Fukami

  3. Department of Surgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan

    Eiji Sakamoto

  4. Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan

    Hideo Miyake

  5. Department of Surgery, Kiryu Kosei General Hospital, Kiryu, Japan

    Daisuke Takara

  6. Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kenji Wakai

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  1. Kenichi Komaya
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  8. Masato Nagino
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The Nagoya Surgical Oncology Group

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Correspondence to Masato Nagino.

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Komaya, K., Ebata, T., Fukami, Y. et al. Percutaneous biliary drainage is oncologically inferior to endoscopic drainage: a propensity score matching analysis in resectable distal cholangiocarcinoma. J Gastroenterol 51, 608–619 (2016). https://doi.org/10.1007/s00535-015-1140-6

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  • DOI: https://doi.org/10.1007/s00535-015-1140-6

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