Journal Article (Review Article)

DKFZ-2026-02254

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Biliary drainage in perihilar cholangiocarcinoma: historical rationale and the evolving case for selective use.

Luyten, J. A. ; Clark, B. J. ; de Vos-Geelen, J. ; Schaap, F. G. ; van Delden, O. ; Poley, J.-W. ; van Gulik, T. ; Koerkamp, B. G. ; Neumann, U. P. ; Dewulf, M. J. L. ; Olde Damink, S. W. M.DKFZ*

2026
Taylor & Francis Abingdon, Oxon

Abstract: Cholestasis prevents optimal treatment of perihilar cholangiocarcinoma (pCCA). To counteract this, biliary drainage (BD) has long been regarded as mandatory prior to any treatment. However, increasing evidence has highlighted the risks associated with BD, notably cholangitis, indicating that while often necessary, drainage requires careful clinical judgment.This narrative literature review outlines the historical development of BD and its rationales, including the restoration of liver function, a prerequisite for liver hypertrophy-inducing procedures, and improvement of performance status. The review also addresses its drawbacks, particularly the risk of cholangitis due to bacterial colonization of the biliary tree and summarizes the evidence shaping contemporary clinical practice.Once regarded as mandatory, BD can no longer be justified as a routine intervention for every pCCA patient, given the associated risks. Undrained partial hepatectomy should be considered in patients with moderate bilirubin levels, adequate future liver remnant volume, absence of cholangitis, normal performance status, and preserved liver and renal function. Still, this applies to only a minority of patients. Similarly, systemic therapy may be feasible without BD in highly selected patients. Future research should focus on defining selection criteria, investigating new biomarkers of cholestasis, and refining drainage techniques to minimize complications of BD.

Keyword(s): Biliary drainage ; Cholestasis ; cholangitis ; obstructive jaundice ; perihilar cholangiocarcinoma ; preoperative drainage ; primary metal stenting

Note: #DKTKZFB26# / epub

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Contributing Institute(s):

1. DKTK Koordinierungsstelle Essen/Düsseldorf (ED01)
2. DKTK ED Translationale Onkologie Solider Tumore (ED04)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2026

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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