Clinical Outcome of Biliary Drainage for Obstructive Jaundice Caused by Colorectal and Gastric Cancers

Abstract

Objective: To clarify the prognostic factors for patients with obstructive jaundice due to advanced colorectal and gastric cancers who had undergone percutaneous transhepatic biliary drainage. Methods: Baseline variables and clinical outcomes were evaluated for 92 consecutive patients treated with percutaneous transhepatic biliary drainage. Results: Of the 92 patients, 32 (35%) had colorectal cancer and the remaining 60 (65%) had gastric cancer. Percutaneous transhepatic biliary drainage was successfully achieved in 74 (80%) patients, and 39 of them could receive subsequent chemotherapy. The median survival after percutaneous transhepatic biliary drainage was 273 days in the 39 patients who had undergone successful percutaneous transhepatic biliary drainage and subsequent chemotherapy, 65 days in 35 patients who had undergone successful percutaneous transhepatic biliary drainage but who had not received subsequent chemotherapy and 34 days in the remaining 18 patients who had undergone unsuccessful percutaneous transhepatic biliary drainage (P , 0.001). Multiple liver metastases and hepatic hilar bile duct stricture were independently associated with unsuccessful percutaneous transhepatic biliary drainage. Poor performance status, multiple liver metastases, presence of ascites, multiple prior chemotherapy administrations, undifferentiated type histology and high serum CA19-9 level were independently associated with a poor prognosis. A prognostic index calculated based on the number of these six factors was used to classify the patients into a good-risk group (index 2) (n ¼ 56) and a poor-risk group (index 3) (n ¼ 36). The median survival time and 2-month survival rate for the two groups were 163 and 44 days, respectively, and 85.7 and 33.3%, respectively (P , 0.001). Conclusions: As regards the introduction of percutaneous transhepatic biliary drainage in patients with obstructive jaundice due to colorectal and gastric cancers, careful patient selection might be necessary. A prognostic model seems to be useful for making decisions as to whether percutaneous transhepatic biliary drainage is indicated for particular patients.

Percutaneous biliary drainage catheter insertion in patients with extensive hepatic metastatic tumor burden

“…While previous studies in patients with advanced solid malignancies have demonstrated median overall survival of up to 2.9 months, 90% of patients were eligible for chemotherapy following PBD placement (12). Kasuga et al reported that multiple liver metastases and multiple prior chemotherapy administrations were both independently associated with a poorer prognosis following PBD insertion, with median survivals of 65 and 34 days in patients with successful and unsuccessful PBD insertion (9). While the degree of hepatic tumor burden was not reported in these other studies, all patients in the current study had extensive hepatic tumor burden that may not be treated at all centers.…”

Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction

“…[22] Previous studies have described that obstructive jaundice with poor prognostic factors could not receive survival benefit from PTBD, even though they achieved an improvement of their liver dysfunction. [23] For this reason, few studies investigated the prognostic factors that predict short survival time in these patients. [11,13,19,23] By identifying poor predictive survival factors, we believe that through pre-PTBD clinical, radiological, and laboratory data analysis, we can identify the population of patients for whom PTBD will not increase well-being or survival, and in return, such invasive procedure can be avoided.…”

“…[23] For this reason, few studies investigated the prognostic factors that predict short survival time in these patients. [11,13,19,23] By identifying poor predictive survival factors, we believe that through pre-PTBD clinical, radiological, and laboratory data analysis, we can identify the population of patients for whom PTBD will not increase well-being or survival, and in return, such invasive procedure can be avoided. In this study, we aimed to address two main issues: the survival of patients with malignant biliary obstruction post percutaneous drainage; and to describe the prognostic factors that predict short survival time after percutaneous biliary drainage.…”

“…The median survival rate was 273 days for patients who had successful chemotherapy after undergoing PTBD, 65 days for patients who had undergone successful percutaneous transhepatic biliary drainage without receiving subsequent chemotherapy and 34 days in the remaining patients who had undergone unsuccessful percutaneous transhepatic. [23] Van Laethem et al evaluated 16 patients and found that patients who had additional chemotherapy after complete resolution of jaundice had a longer survival period. [24] In a study done by Teixeira and colleagues, the median survival period after PTBD was 2.9 months, more than half of their cohort received subsequent chemotherapy.…”

“…The median survival time and 2-month survival rate for the two groups were 163 and 44 days, respectively, and 85.7 and 33.3%, respectively (P = 0.001). [23] One of the strengths of this study is that all PTBD were done by the same interventional radiologists, and hence, there is no role for operator difference in the outcomes measured. Second, there was no missing pre-and postprocedure data.…”