Are endoscopic or percutaneous biliary drainage effective for obstructive jaundice caused by hepatocellular carcinoma?

OBJECTIVES

The prognosis of patients with obstructive jaundice caused by hepatocellular carcinoma (HCC) has been reported to be poor. The aims of this study were to determine whether effective biliary drainage in patients with obstructive jaundice caused by HCC can affect clinical outcome and to identify those factors that affect effective biliary drainage and clinical outcome.

METHODS

The clinical records of 68 patients with obstructive jaundice caused by HCC who underwent endoscopic or percutaneous transhepatic biliary drainage from 1 January 2004 to 31 December 2008 were analyzed. Effective biliary drainage was defined as a decrease in total bilirubin level of more than 30% of the preprocedural value within 4 weeks.

RESULTS

(i) Effective biliary drainage was achieved in 51.5% of the patients who underwent a biliary drainage procedure. The independent risk factors for ineffective biliary drainage were total bilirubin more than 13 mg/dl and Child-Turcotte-Pugh class C. (ii) Patients with effective biliary drainage showed a significant improvement of Child-Turcotte-Pugh class and received additional treatment for HCC. (iii) The mean survival times of patients who received effective or ineffective biliary drainage were 247 and 44 days, respectively. (iv) The independent risk factors of mortality were an age of more than 63 years, ineffective biliary drainage, and no following treatment for HCC.

CONCLUSION

When effective biliary drainage was achieved after an appropriate biliary drainage procedure in patients with obstructive jaundice caused by HCC, survival improved.