Abstract
Background: There is much controversy as to the importance of establishing drainage of both
liver lobes in malignant hilar obstruction. The purpose of the present study was to
compare survival data in patients with malignant hilar obstruction, stratified according
to the Bismuth classification, who had cholangiography with filling of one or both
hepatic ducts and subsequently endoscopic or percutaneous drainage of one or both
ducts. Methods: A retrospective review was performed for the time period from July 1990 to July
1995, and 224 patients were identified with a presumed diagnosis of a bifurcation
tumor. All x-ray films were reviewed and 150 patients finally diagnosed as hilar tumor
were classified according to Bismuth type I, II, or III. Type II and III patients
were further subclassified with respect to contrast injection into a single or both
hepatic duct systems and whether one or both sides were eventually drained. Results: Data were obtained in 141 patients (4 patients still alive); there were 43 type
I, 58 type II, and 40 type III. Type II and III patients were divided into three groups:
group A, one lobe opacified with same lobe drained; group B, both lobes opacified
with both lobes drained; and group C, both lobes opacified with one lobe drained.
Overall median survival for type I, II, and III patients was 160, 131, and 62 days,
respectively. Among type II and III patients the median survivals of groups A, B,
and C were 145, 225, and 46 days, respectively. Survival was significantly longer
in group A vs. group C (p < 0.001), group B vs. group C (p < 0.001, and group A + B (165 days) vs. group C p < 0.001). There was no difference in group A + B versus type I (p = 0.90). In addition, when comparing single drain only (group A + C, 80 days) versus
double drains (group B, 225 days), there was a significant survival advantage (p < 0.0001). Conclusion: In bifurcation tumors the best survival was noted in those with bilateral drainage,
and the worst survival in those with cholangiographic opacification of both lobes
but drainage of only one. (Gastrointest Endosc 1998;47:354-62.)
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Article info
Publication history
Accepted:
December 20,
1997
Received in revised form:
May 28,
1997
Received:
January 17,
1997
Footnotes
☆From the Division of Gastroenterology, The Centre for Advanced Therapeutic Endoscopy and Endoscopic Oncology, The Wellesley Hospital, University of Toronto, Toronto, Ontario, Canada.
☆☆Reprint requests: Gregory B. Haber, MD, The Centre for Therapeutic Endoscopy and Endoscopic Oncology, 160 Wellesley St. East, Toronto, Ontario, Canada M4X 1J3.
★*Current address: Division of Gastroenterology, Mackay Memorial Hospital, Taipei, Taiwan.
★★37/1/88342
Identification
Copyright
© 1998 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
