Selection of preoperative biliary drainage procedure for resectable hilar cholangiocarcinoma

Objective To compare the efficacy of two types of preoperative biliary drainage procedure [percutaneous transhepatic biliary drainage(PTBD) vs.stent drainage through endoscopic retrograde cholangiopancreatography(ERCP)] for recectable hilar cholangiocarcinoma. Methods The clinical data of 58 patients with resectable hilar cholangiocarcinoma undergoing preoperative biliary drainage with PTBD(35 cases) or ERCP(23 cases) from January 2004 to January 2011 were analyzed.The success rate of operation,incidence of complications and biliary tract infection as well as the drainage effects between the two groups were compared. Results The preoperative medical data of the patients between the two groups had no statistical differences.The success rate of initial drainage was 100% in the PTBD and 87% in the ERCP group(P=0.057).Two cases of biliary tract bleeding occurred in PTBD group;while one case of duodenal perforation,2 cases of papilla bleeding and 4 cases of acute pancreatitis occurred in ERCP group.The incidence of biliary tract infection of ERCP group was significantly higher than that of PTBD group(43% vs.17%,P=0.028).The jaundice was reduced to a satisfactory level before surgery in both groups.However,longer drainage period and more drain replacements were required in ERCP group than those in PTBD group(7 weeks vs.4.5 weeks,P=0.035;2.5 times vs.1.2 times,P=0.029).Eight cases(34.8%) in ERCP group were converted to PTBD procdure,of which the biliary tract infection rate was 75.0%,mean drain replacement was 4 times and mean drainage period was 8 weeks before surgery,respectively.Two cases(5.7%) of PTBD group were converted to ERCP internal drainage due to large volume of bile outflow(more than 2 000 mL/d). Conclusions For resectalbe hilar cholangiocarcinona patients preoperaive PTBD has more advantages than ERCP stent placement,showing fewer procedure-related complications and biliary infections and requiring less drain replacements,but the selection of which procedure to perform in clinical practice should be based on the particular conditions of the patients.