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Palliative surgery for hilar cholangiocarcinoma
Hai-Min Li1, Ke-Feng Dou, Kai Sun
1Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China. lihaim@fmmu.edu.cn
Hepatobiliary & Pancreatic Diseases International : HBPD INT
|November 11, 2003
Summary
Palliative surgery for hilar cholangiocarcinoma improves quality of life and survival. Roux-en-Y choledochojejunostomy offers the best outcomes, significantly reducing cholangitis rates compared to other palliative procedures.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Hilar cholangiocarcinoma (Bismuth-II/III) often presents as unresectable, necessitating palliative treatment.
- Palliative surgical options aim to relieve biliary obstruction, improve quality of life, and prolong survival.
Purpose of the Study:
- To evaluate the efficacy of various palliative surgical treatments for unresectable hilar cholangiocarcinoma.
- To compare outcomes in terms of quality of life, survival duration, and incidence of cholangitis.
Main Methods:
- Retrospective analysis of 232 patients with hilar cholangiocarcinoma over 22 years.
- Palliative procedures included choledochojejunostomy, bridge internal drainage, endoscopic biliary drainage, percutaneous transhepatic biliary drainage, and exploratory celiotomy with external drainage.
Main Results:
- Operative mortality was 9.1% with no significant intergroup difference.
- Roux-en-Y choledochojejunostomy and bridge internal drainage showed significantly lower cholangitis rates (16.2% and 15.4%) compared to other methods (35.5%-39.1%).
- Roux-en-Y choledochojejunostomy and internal drainage groups had longer survival (9.3±1.8 and 8.7±2.2 months) than bridge internal drainage and external drainage groups.
Conclusions:
- Palliative bilioenteric bypass or percutaneous transhepatic biliary drainage effectively palliates unresectable cholangiocarcinoma.
- Roux-en-Y choledochojejunostomy is the preferred palliative surgical option.
- U-tube drainage is recommended for internal radiation therapy in selected cases.