Assessment of Outcomes of Palliative Radiologic Percutaneous Biliary Drainage and Metal Stenting in Adult Patients With Malignant Hilar Biliary Obstruction.

OBJECTIVE: Review outcomes for patients undergoing biliary drainage and stenting via percutaneous transhepatic cholangiography, drainage, and stenting (PTCDS) for malignant hilar biliary obstruction secondary to hepatopancreaticobiliary (HPB) tumors versus other tumor types, to identify factors which predict poor outcomes and assist discussions with patients and clinicians.

METHODS: Retrospective search electronic medical records for adult patients who underwent PTCDS for malignant hilar obstruction. The primary endpoint was in-hospital bilirubin reduction, with secondary endpoints of progression to further systemic therapy, length of hospital stay, and overall survival from procedure date.

RESULTS: Within the cohort of 50 patients, PTCDS led to a statistically significant reduction in bilirubin (p < 0.0001). The median overall survival was 81.9 days, with a median hospital stay of 11.5 days. Nineteen patients had further systemic therapy. There was no significant difference in bilirubin improvement between different cancer types, and bilirubin improvement was positively correlated with survival and with having further systemic therapy (p = 0.016). There was no significant difference in overall survival between patients with HPB cancers versus other cancers (p = 0.49). Background cirrhosis of the liver (p = 0.03) and the presence of more than one liver lesion (p = 0.02) independently negatively impacted survival. There was no impact of any covariate on the length of hospital stay.

CONCLUSION: PTCDS for malignant biliary obstruction has a beneficial role in the palliative management of cancer patients, but should only be pursued with very significant caution in those with background liver cirrhosis and in those with a large burden of hepatic disease.