Palliative Surgical Bypass versus Percutaneous Transhepatic Biliary Drainage on Unresectable Hilar Cholangiocarcinoma
Narongchai Wongkonkitsin MD*, Ake Phugkhem MD*, Kriangsak Jenwitheesuk MD*, O-Tur Saeseow MD*, Vajarabhongsa Bhudhisawasdi MD*
Affiliation : * General Surgery 3 Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen
Objective : To compare the survival probability of unresectable hilar cholangiocarcinoma patients who have
been managed by palliative surgical bypass versus percutaneous transhepatic biliary drainage (PTBD).
Materials and Methods : A historical (retrospective) cohort study was performed by retrospective and prospec-
tive data collection. From January 1, 2000 to December 31, 2002, all unresectable hilar cholangiocarcinoma
patients who received only one type of palliative surgical bypass or PTBD in Srinagarind Hospital, Khon
Kaen University were included in the present study. The patients were followed until December 31, 2004.
Survival analysis was completed for all of the patients.
Statistic analysis: Survival analysis was analyzed with the Kaplan-Meier method, Cox regression analysis,
and Log-rank test. A p-value of less than 0.05 was considered significant.
Results : During the study period, 83 patients were included. Palliative surgical bypass was performed in 42
patients and PTBD was performed in 41 patients. Demographic data, peri-operative complication rate, and
late complication rate were comparable. The median survival time of the palliative surgical bypass group was
160 days (95%CI: 85.33, 234.67) and 82 days (95%CI: 29.76, 134.24) for PTBD group. Comparing survival
experience by Log-rank test gave statistical significant difference (p = 0.0276). Hazard ratio was 0.599 (p =
0.03)
Conclusion : Survival rate of the palliative surgical bypass group was higher than the PTBD group. The
survival rate of both groups was comparable to previous reports.
Keywords : Cholangiocarcinoma, Hilar, Klatskin’s tumor, Unresectable, Palliative surgical bypass, PTBD, Survival rate
