title: Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma.
abstract: BACKGROUND
  Surgical results of patients with resected distal cholangiocarcinoma (DCC) were evaluated to elucidate prognostic impact of the type of preoperative biliary drainage (PBD).
  
  
  METHODS
  Eighty-eight patients with resected DCC were stratified into two groups according to the type of PBD: the percutaneous transhepatic biliary drainage (PTBD) group (n = 25) and the endoscopic biliary drainage (EBD) group (n = 63).
  
  
  RESULTS
  Overall 5-year survival rate of the patients in the PTBD group was poorer than in the EBD group (24% vs. 52%, P = 0.020). On univariate analysis, PTBD, pancreatic invasion, perineural invasion, and lymph node involvement were significant prognostic factors for poor overall survival. On multivariate analysis, PTBD was the only significantly independent prognostic factor for poor overall survival. The incidence of liver metastasis was significantly higher in the PTBD group than in the EBD group (32.0% vs. 13.3%, P = 0.034).
  
  
  CONCLUSIONS
  PTBD should be avoided as much as possible in patients with DCC since the patients who underwent PTBD had poorer overall survival and higher incidence of liver metastasis than those who underwent EBD.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan. Electronic address: f-miura@med.teikyo-u.ac.jp.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Shibuya
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kainuma
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Kawamura
authors.affiliation: Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hayano
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Japan.
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
keywords: Distal cholangiocarcinoma; Endoscopic biliary drainage; Percutaneous transhepatic biliary drainage; Preoperative biliary drainage