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. 2021 Jun 17:13:4767-4776.
doi: 10.2147/CMAR.S308833. eCollection 2021.

A Retrospective Study of Biliary Drainage Strategies for Patients with Malignant Hilar Biliary Strictures

Xin-Yue Liang  1   2 , Wen Li  1   2 , Fang Liu  1   2 , Xin-Dan Kang  1   2
Affiliations

A Retrospective Study of Biliary Drainage Strategies for Patients with Malignant Hilar Biliary Strictures

Xin-Yue Liang et al. Cancer Manag Res. .

Abstract

Purpose: The main aim of this study was to compare the efficacy and safety of different biliary drainage strategies, including percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary stenting (EBS) and unilateral versus bilateral stenting, in patients with unresectable malignant hilar biliary strictures (MHBSs).

Patients and methods: This was a retrospective review of patients with inoperable MHBSs who underwent biliary drainage by either EBS or PTBD. Efficacy and safety were compared between the two pathways and between unilateral and bilateral stenting in the EBS group. The survival duration was analyzed with K-M curves and Log rank tests.

Results: From January 2015 to December 2019, a total of 206 (126: EBS and 80: PTBD) patients with MHBSs were enrolled in our study and underwent 270 procedures (173: EBS and 97: PTBD). Bilateral stenting was superior to unilateral stenting in terms of clinical success (69.6% vs 50.6%, p=0.039), especially for patients with Bismuth type IV (70.0% vs 30.3%, p=0.002). A higher decrease in bilirubin was seen with PTBD in patients with Bismuth types III-IV (66.9 vs 36.7, p=0.006). A survival advantage was seen in successful drainage (227 days vs 82 days, p<0.001), lower tumor-node-metastasis (TNM) scores (I-II) (195 days vs 139 days, p=0.012), and cholangiocarcinoma (184 days vs 84 days, p=0.001).

Conclusion: For patients with advanced MHBSs, bilateral stenting may achieve a better drainage effect than unilateral stenting, and PTBD may have a better performance in relieving cholestasis than EBS. Successful drainage and cholangiocarcinoma may provide greater long-term survival benefits.

Keywords: endoscopic biliary stenting; inoperable hilar malignancy; percutaneous transhepatic biliary drainage; survival.

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Conflict of interest statement

The authors report no conflicts of interest related to this work.

Figures

Figure 1
Figure 1
Survival time curve obtained by Kaplan-Meier analysis shows no difference between EBS and PTBD (P = 0.057).
Figure 2
Figure 2
Survival time curve obtained by Kaplan-Meier analysis shows no difference between unilateral and bilateral drainage (P = 0.371).
Figure 3
Figure 3
Kaplan-Meier analysis of survival between patients with or without clinical success. Cumulative survival rates were significantly higher in patients with CS (green line) (P = 0.000).
Figure 4
Figure 4
Kaplan-Meier analysis of survival between patients with TNM I–II and those with TNM III–IV. Cumulative survival rates were significantly higher in patients with TNM I-II (blue line) (P = 0.012).
Figure 5
Figure 5
Kaplan-Meier analysis of survival between patients with cholangiocarcinoma and those with other tumors. Cumulative survival rates were significantly higher in patients with cholangiocarcinoma (green line) (P = 0.001).
See this image and copyright information in PMC

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