Predictive factors for survival of patients with inoperable malignant distal biliary strictures: a practical management guideline

Abstract

Background-Stenting is the treatment of choice for inoperable malignant strictures of the common bile duct. Criteria for the choice of stents (plastic versus metallic) remain controversial because predicting survival is diYcult. Aims-To define prognostic factors in order to improve the cost eVectiveness of endoscopic palliation. Patients-One hundred and one patients were included in a prospective trial. Seven prognostic variables for survival were analysed (age, sex, bilirubinaemia, weight loss, presence of liver metastases, and tumour histology and size). All patients were followed until death or at least one year after inclusion. By the end of the study, 81 (80.2%) patients had died. Results-In univariate analysis, the variables associated with survival were weight loss (p<0.05) and tumour size (p<0.01). By multivariate analysis, tumour size was the only independent prognostic factor (p<0.05). A threshold of 30 mm at diagnosis distinguished two survival profiles: the median survival of patients with a tumour greater than 30 mm was 3.2 months, whereas it was 6.6 months for patients with a tumour less than 30 mm (p<0.001). Conclusions-A practical strategy could be based on tumour size at diagnosis: a metal stent should be systematically chosen for patients with an inoperable tumour smaller than 30 mm, while larger tumours are eYciently palliated by a plastic stent. (Gut 1998;42:76-80)

Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

“…Studies comparing surgical to non-surgical biliary drainage showed similar overall palliative effects but with higher perioperative morbidity and mortality [263,264] . Surgical drainage has the advantage of superior patency rates and prevents the need for stent exchanges required when using endoscopic or percutaneous stents due to clogging [265] . Currently, the main candidates for surgical drainage are patients found to have unresectable CC at the time of exploration, individuals who are not able to undergo repeat endoscopic or percutaneous stent exchanges, and those who have long expected survival and who are fit for surgery [183,266] .…”

Surviving Against All Odds: Analysis of 6 Case Studies of Patients With Cancer Who Followed the Gerson Therapy

“…Case 5 is, however, a fascinating example of someone who declined conventional treatment of a cancer that untreated would have reduced the patient's survival to 3.2 to 6.6 months. 11,12 While on the Gerson regimen, he experienced a very slowly progressing cancer and a 6-year survival. Furthermore, case 4 had only 1 cycle of chemotherapy, unlikely to have sufficiently managed her lymphoma.…”

Percutaneous transhepatic biliary stenting: The first experience and results of the Hospital of Kaunas University of Medicine

“…Type IV lesion are generally considered to be unresectable (6). Approximately 80% to 90% of these patients will be found unresectable (3,7,10,11). Prognosis of latter patients is dismal.…”

“…At the time of diagnosis, 90% of patients with malignant obstruction of bile ducts may benefit from palliative treatment only and have a very poor prognosis (3,7). Palliation of unresectable malignancies requires a multidisciplinary approach including medical oncologists, radiation oncologists, gastroenterologists, hepatobiliary surgeons, and interventional radiologists.…”