ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Hepato Pancreatic Biliary Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1504604
Hilar cholangiocarcinoma patients accepting preoperative percutaneous transhepatic biliary drainage experienced high incidence of portal vein invasion and lymph node metastasis
Provisionally accepted
- 1Caidian District People's Hospital of Wuhan, Wuhan, Hebei Province, China
- 2PLA Middle Military Command General Hospital, wuhan, China
- 3General Hospital of Xinjiang Military Command, Urumqi, China
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Background: Percutaneous transhepatic biliary drainage (PTBD) was widely used for bile drainage in hilar cholangiocarcinoma (HCCA) patients, due to its exact effectiveness in relieving obstructive jaundice. However, the potential association between PTBD and increased local tumor spread (including portal vein invasion and lymph node metastasis) remained unclear, as this procedure might prolong the waiting time and lead to potential risks of portal vein injury. This study aimed to investigate whether HCCA patients undergoing PTBD exhibit higher risks of portal vein invasion and lymph node metastasis after radical resection.The clinical data of 341 HCCA patients was retrospectively analyzed. PTBD was exclusively used as the preoperative biliary drainage method, excluding patients who underwent endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting (EBS). Portal vein invasion and lymph node metastasis were verified by postoperative pathological examinations.Results: In this study, 163 patients (47.8%) received preoperative PTBD. These patients experienced significantly higher risks of portal vein invasion (OR: 1.86, p = 0.027) and lymph node metastasis (OR: 1.94, p = 0.008) compared to those 178 patients (52.2%) in the non-PTBD group. The Kaplan-Meier survival analysis revealed significantly better OS (p = 0.039) in the non-PTBD group. Causal mediation analysis revealed that the effect of PTBD on survival was partly mediated by portal vein invasion and lymph node metastasis. Additionally, the length of hospitalization in PTBD group was obviously longer (26.7 days vs 21.8 days, p = 0.002).Preoperative PTBD was associated with increased incidence of portal vein invasion and lymph node metastasis in HCCA patients accepting R0 resection.
Keywords: HCCA, PTBD, Portal vein invasion, lymph node metastasis, Survival
Received: 01 Oct 2024; Accepted: 19 May 2025.
Copyright: © 2025 Cai, Yao, Dong, Wang, Luo and Heng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gang Heng, PLA Middle Military Command General Hospital, wuhan, China
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