Differential effects of preoperative cholangitis and biliary stenting in long-term survival of patients undergoing surgery for perihilar cholangiocarcinoma.

BACKGROUND

Painless icterus, elevated cholestatic parameters and cholangitis are among the most common symptoms associated with patients with perihilar cholangiocarcinoma. Preoperative optimization of these conditions is crucial and usually done through preoperative biliary stenting. Cholangitis is a frequent complication of biliary obstruction through tumor, and of stenting, but its impact on surgical and oncologic outcomes remains controversial.

METHODS

We analyzed patients undergoing curative-intent surgery for perihilar cholangiocarcinoma. Clinical, laboratory, operative and pathological data were collected. Propensity score matching was performed to minimize baseline differences. Outcomes of patients with and without preoperative cholangitis were compared, with particular focus on survival in relation to preoperative biliary stenting.

RESULT: Of 305 patients, 204 remained after prospective score matching for baseline characteristics, including 108 with cholangitis and 96 without. Severe complications (Clavien Dindo IV-V) were more common in patients with cholangitis (25 % vs. 13.8%, p = 0.028). Median overall survival was significantly shorter in patients with cholangitis (2.05 vs. 3.03 years, p = 0.014), as was disease-free survival (1.26 vs. 2.21 years, p = 0.0006). Patients with both stenting and cholangitis had the poorest overall survival, when compared to those with stenting only (3.63 years) or those without stenting and without cholangitis (2.31 years, p = 0.03).

CONCLUSION

Preoperative cholangitis, particularly when combined with biliary stenting, is associated with significantly worse perioperative outcomes and long-term survival in patients with perihilar cholangiocarcinoma. These results underscore the importance of prophylactic antibiotics in the preoperative phase and call for strategies aimed at reducing stent-associated cholangitis.