title: Palliative treatment in patients with unresectable hilar cholangiocarcinoma: results of endoscopic drainage in patients with type III and IV hilar cholangiocarcinoma.
abstract: OBJECTIVE
  To find out how patients fared after palliative endoscopic biliary drainage for inoperable hilar cholangiocarcinoma.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital, the Netherlands.
  
  
  METHODS
  Between 1992 and 1999, 41 patients who were referred for resection had tumours that were considered unresectable after additional investigations, including an exploratory laparotomy in 16 patients. In all patients, biliary drainage was established by endoscopic retrograde cholangiography (ERCP) and insertion of endoprostheses. Twelve patients also had percutaneous transhepatic biliary drainage (PTBD).
  
  
  RESULTS
  The patients who did not have an exploratory laparotomy had fewer complications (1/25) than those who had explorations (4/16). All patients in both groups had one or more long-term complications during follow-up, of which cholangitis, jaundice, and abdominal pain were the most often recorded. In 32 patients, endoprostheses had to be replaced, a mean of 4 times. Median survival was 9 months, with no significant difference between the groups (8 and 11 months). Adjuvant radiotherapy had no influence on survival.
  
  
  CONCLUSIONS
  The patients in this series had relatively long survival times, during which they had a substantial number of complications predominantly related to biliary drainage. Because biliary-enteric bypass operations result in effective relief of symptoms and excellent palliation, we suggest that when an exploration is done for patients with type III and IV tumours, a bypass should be made.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Gerhards
authors.forename: D
authors.initials: D
authors.lastname: den Hartog
authors.forename: E A
authors.initials: EA
authors.lastname: Rauws
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: D
authors.initials: D
authors.lastname: González González
authors.forename: J S
authors.initials: JS
authors.lastname: Lameris
authors.forename: L T
authors.initials: LT
authors.lastname: de Wit
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011183:Postoperative Complications