UNRESECTABLE HILAR CHOLANGIOCARCINOMA - PERCUTANEOUS VERSUS OPERATIVEPALLIATION

Background. Several nonoperative and operative options are available f or palliation of patients with unresectable hilar cholangiocarcinoma. This retrospective analysis compares the results of nonoperative percu taneous stenting and operative palliation in 65 patients. Methods. Twe nty-one patients were managed with percutaneous biliary stents (group A), and 44 patients underwent laparotomy (group B) with placement of l arge-bore silicone rubber transhepatic stents in 33. The two groups we re similar with respect to age, gender, mean laboratory data, and chol angiographic extent of tumor. Results. Group A and group B patients we re comparable in hospital morbidity (67% vs 61%), hospital mortality ( 14% vs 7%), and mean initial hospital stay (27 vs 31 days). Survival w as greater in group B laparotomy patients at 1, 3, and 6 months (p < 0 .01), and median survival was 5 months for group A compared with 8 mon ths for group B patients (p = 0.06). Group A patients who were managed with percutaneous stents required more stent changes per month of sur vival (0.5 vs 0.3, p = 0.06). However, group B patients who underwent operative palliation were more likely to undergo a second operation (0 % vs 21%, p = 0.05), most often for duodenal or small-bowel obstructio n. Conclusions. Operative placement of large-bore transhepatic stents may reduce cholangitis, delay hepatic failure, and prolong survival. W e conclude that patients with unresectable hilar cholangiocarcinoma wh o are fit for surgery may benefit from operative palliation.