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THE APPROACH TO BILIARY DRAINAGE IMPACTS POST-PROCEDURE INFECTIOUS COMPLICATIONS FOR PATIENTS WITH PERI-HILAR AND INTRAHEPATIC CHOLANGIOCARCINOMA: A SEER-MEDICARE DATA ANALYSIS
Christine M. Kariya*1, Winifred M. Lo1, Madeline B. Torres1, Jessica L. Petrick2, Timothy S. McNeel3, Sean Martin1, Samantha Ruff1, Laurence Diggs1, Kaitlin C. McLoughlin1, Justin Drake1, Michael Wach1, Zachary Brown1, Reed Ayabe1, Jeremy L. Davis1, Katherine A. McGlynn2, Jonathan M. Hernandez1
1Thoracic and GI Oncology Branch, National Cancer Institute, Bethesda, MD; 2National Cancer Institutue, Rockville, MD; 3Information Management Services, Rockville, MD
Introduction: The optimal approach to biliary drainage for patients with obstructing peri-hilar and intrahepatic cholangiocarcinoma (CCA) remains unclear. Given that violation of the sphincter of Oddi results in bacterial colonization of the biliary tree, we sought to determine if the type of biliary drainage impacts post-procedural infectious complications.
Methods: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database from 1991-2013. Patients with peri-hilar and intrahepatic cholangiocarcinoma were identified using ICD-O topography and morphology codes and stratified by biliary drainage procedures as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP) using CPT codes. We defined infectious complications using ICD-9 codes. Patients were sub-stratified based on resection status for the analysis.
Results: 1597 patients were included in the final analysis. The cohort was 49% male, 81% white, and the mean age was 79 years. The median overall survival for all patients was 3.9 months from biliary drain placement. Drainage approach (SOV vs. SOP) was not associated with age at drain placement, sex, number of comorbidities, or tumor stage. Hepatic resections were undertaken in 311 patients (SOV 292; SOP 19). For patients undergoing resection, the 30 and 90-day infection rates did not significantly differ (71% and 85% for SOV vs. 74% and 84% for SOP). In these patients, the method of biliary drainage (SOV vs SOP) was not significantly associated with rates of cholangitis, bacteremia, or sepsis. 1286 patients underwent biliary drainage procedures (SOV 1192; SOP 94) and did not undergo a resection. For patients managed without a resection, the 30 and 90-day infection rates were 64% and 75% vs. 46% and 49% for SOV and SOP, respectively (p = 0.0005 and p <0.0001). For this nonoperative group, those undergoing SOV procedures experienced higher rates of cholangitis at 30-days (24% vs 14%, p =0.022) and 90-days (34% vs 15%, p = 0.0002) after the procedure.
Conclusion: Biliary drainage methods that preserve the sphincter of Oddi appear to be associated with fewer post-procedural infectious complications, including cholangitis. For patients with inoperable peri-hilar and intrahepatic cholangiocarcinoma, consideration should be given to sphincter-preserving approaches.
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