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Best options for preoperative biliary drainage in patients with Klatskin tumors

 Jung Hyun Jo  ;  Moon Jae Chung  ;  Dai Hoon Han  ;  Jeong Youp Park  ;  Seungmin Bang  ;  Seung Woo Park  ;  Si Young Song  ;  Jae Bock Chung 
 Surgical Endoscopy , Vol.31(1) : 422-429, 2017 
Journal Title
 Surgical Endoscopy  
Issue Date
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/complications ; Bile Duct Neoplasms/surgery* ; Cholestasis/etiology ; Cholestasis/surgery* ; Decompression, Surgical ; Drainage/methods* ; Endoscopy/methods* ; Female ; Humans ; Klatskin Tumor/complications ; Klatskin Tumor/surgery* ; Male ; Middle Aged ; Preoperative Care/methods* ; Retrospective Studies ; Stents*
Endoscopic biliary stenting ; Endoscopic nasobiliary drainage ; Klatskin tumors ; Percutaneous transhepatic biliary drainage ; Preoperative biliary drainage
Operative treatment combined with PBD has been established as a safe management strategy for Klatskin tumors. However, controversy exists regarding the preferred technique for PBD among percutaneous transhepatic biliary drainage (PTBD), endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD). This study aimed to identify the best technique for preoperative biliary drainage (PBD) in Klatskin tumor patients. METHODS: This study evaluated 98 Klatskin tumor patients who underwent PBD prior to operation with a curative aim between 2005 and 2012. The PTBD, EBS, and ENBD groups included 43, 42, and 13 patients, respectively. Baseline characteristics, technical success rate, complications of PBD, and surgical outcomes were compared. RESULTS: Initial technical success rates (97.3 %, PTBD; 90.2 %, endoscopic methods, including EBS and ENBD) and mean duration until biliary decompression (31.0, PTBD; 28.7, EBS; 35.8 days, ENBD) were not significantly different between the groups. Total frequency of complications did not significantly differ between the EBS group (42.9 %) and the PTBD (27.9 %, p = 0.149) and ENBD (15.4 %, p = 0.072) groups. The ENBD group showed a significantly higher rate of conversion to other methods (76.9 %) than the PTBD (4.7 %, p < 0.0001) and EBS (35.7 %, p = 0.009) groups. CONCLUSIONS: PTBD, EBS, and ENBD showed comparable results regarding initial technical success rates, complication rates, and surgical outcomes. As Klatskin tumor patients must undergo PBD prior to 3 weeks before surgery, PTBD and ENBD are uncomfortable and disadvantageous in terms of compliance. EBS was the most suitable method for initial PBD in terms of compliance among Klatskin tumor patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
박승우(Park, Seung Woo) ORCID logo https://orcid.org/0000-0001-8230-964X
박정엽(Park, Jeong Youp) ORCID logo https://orcid.org/0000-0003-0110-8606
방승민(Bang, Seungmin) ORCID logo https://orcid.org/0000-0001-5209-8351
송시영(Song, Si Young) ORCID logo https://orcid.org/0000-0002-1417-4314
정문재(Chung, Moon Jae) ORCID logo https://orcid.org/0000-0002-5920-8549
정재복(Chung, Jae Bock)
조중현(Jo, Jung Hyun) ORCID logo https://orcid.org/0000-0002-2641-8873
한대훈(Han, Dai Hoon) ORCID logo https://orcid.org/0000-0003-2787-7876
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