Percutaneous transhepatic biliary drainage in patients with advanced solid malignancies: prognostic factors and clinical outcomes.

PURPOSE

Obstructive jaundice (OJ) is a cumbersome complication in late-stage malignancies, and percutaneous transhepatic biliary drainage (PTBD) is often used to relieve symptoms and allow chemotherapy (CT).

METHODS

From July 2008 to August 2011, 71 patients (pts) with OJ due to solid malignancies underwent PTBD in our institution. Baseline characteristics, procedure complications, and outcomes were retrospectively collected. The primary objective was to estimate overall survival (OS) after PTBD.

RESULTS

Median age was 60 years, 63% had an ECOG performance status (PS) of 1-2, and 10% were receiving supportive care (SC). Most had primary gastrointestinal tumors (89%) and metastatic disease at diagnosis (59%). Mean hospital stay was 16.6 days (2-90 days), with bilirubin value decreased (BVD) after 80% of procedures. Cholangitis was observed in 66.2% of pts and 60.6% required readmissions. Only 51.6% of pts not in SC were eligible for CT after PTBD. Median OS was 2.9 months (95% CI 0.62-5.2). Prognostic factors on univariate analysis include ECOG ≤2 (6.8 versus 0.79 months, p < 0.0001), BVD (6.7 versus 0.33 months, p < 0.0001), and CT after PTBD (13.7 versus 1.2 months p < 0.0001). On multivariate analysis, CT after procedure was related to better OS (HR 0.15, CI 0.06-0.38, p < 0.001).

CONCLUSIONS

Malignant OJ is a late event in cancer pts. Thorough evaluation is needed before determining eligibility to PTBD due to its high complication and hospitalization rates. In the current analysis, pts with PS >2 and who are not candidates for further CT had a dismal prognosis and should probably not be offered PTBD.