Value of palliative surgery in perihilar cholangiocarcinoma

Purpose The survival rate of patients with irresectable perihilar cholangiocarcinoma is remarkably poor. An essential part of palliation is treatment of obstructive cholestasis caused by the tumor. Currently, this is mainly performed endoscopically by stent or via PTBD, requiring frequent changes of...

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Published in:Langenbeck's archives of surgery 2023-03, Vol.408 (1), p.128-128, Article 128
Main Authors: Dondorf, Felix, Rohland, Oliver, Deeb, Aladdin Ali, Ardelt, Michael, Settmacher, Utz, Rauchfuss, Falk
Format: Article
Language:English
Subjects:
Abdominal Surgery
Bile Duct Neoplasms - pathology
Bile Ducts, Intrahepatic - surgery
Cardiac Surgery
Cholangiocarcinoma - surgery
Cholestasis - etiology
Cholestasis - surgery
General Surgery
Humans
Klatskin Tumor - surgery
Medicine
Medicine & Public Health
Original
Original Article
Palliative Care - methods
Quality of Life
Retrospective Studies
Stents - adverse effects
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
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Summary:Purpose The survival rate of patients with irresectable perihilar cholangiocarcinoma is remarkably poor. An essential part of palliation is treatment of obstructive cholestasis caused by the tumor. Currently, this is mainly performed endoscopically by stent or via PTBD, requiring frequent changes of the stents and limiting health-related quality of life due to the multiple hospital stays needed. The aim of this study was to evaluate surgical palliation via extrahepatic bile duct resection as an option for palliative treatment. Methods Between 2005 and 2016, we treated 120 pCCC patients with primary palliative care. Three treatment strategies were retrospectively considered: extrahepatic bile duct resection (EBR), exploratory laparotomy (EL), and primary palliative (PP) therapy. Results The EBR group required significantly less stenting postoperatively, and the overall morbidity was 29.4% (EBR). After the surgical procedure, fewer subsequent endoscopic treatments for stenting or PTBD were necessary in the EBR group over time. The 30-day mortality was 5.9% (EBR) and 3.4% (EL). The median overall survival averaged 570 (EBR), 392 (EL), and 247 (PP) days. Conclusions In selected pCCC patients, palliative extrahepatic bile duct resection is a feasible option for treatment of obstructive cholestasis and should be reconsidered as a therapy option for these patients even in a palliative setting.
ISSN:1435-2451
1435-2443
1435-2451
DOI:10.1007/s00423-023-02854-z