Percutaneous Preoperative Biliary Drainage for Resectable XXXX : No Association with Survival and No Increase in Seeding Metastases.

@entity1 @entity2318 @entity201 @entity1087
BACKGROUND: Endoscopic biliary drainage (EBD) and percutaneous transhepatic biliary drainage (PTBD) are both used to resolve @entity1087 before surgery for perihilar @entity201 (PHC). PTBD has been associated with seeding metastases. The aim of this study was to compare overall survival (OS) and the incidence of initial seeding metastases that potentially influence survival in @entity1 with preoperative PTBD versus EBD. METHODS: Between 1991 and 2012, a total of 278 @entity1 underwent preoperative biliary drainage and resection of PHC at 2 institutions in the Netherlands and the United States. Of these, 33 @entity1 were excluded for postoperative mortality. Among the 245 included @entity1 , 88 @entity1 who underwent preoperative PTBD (with or without previous EBD) were compared to 157 @entity1 who underwent EBD only. Survival analysis was done with Kaplan-Meier and Cox regression with propensity score adjustment. RESULTS: Unadjusted median OS was comparable between the PTBD group (35 months) and EBD-only group (41 months; P = 0.26). After adjustment for propensity score, OS between the PTBD group and EBD-only group was similar (hazard ratio, 1.05; 95 % confidence interval, 0.74-1.49; P = 0.80). Seeding metastases in the @entity2318 occurred as initial recurrence in 7 @entity1 , including 3 @entity1 (3.4 %) in the PTBD group and 4 @entity1 (2.7 %) in the EBD-only group (P = 0.71). No @entity1 had an initial recurrence in percutaneous catheter tracts. CONCLUSIONS: The present study found no effect of PTBD on survival compared to @entity1 with EBD and no increase in seeding metastases that developed as initial recurrence. These data suggest that PTBD can safely be used in preoperative management of PHC.
