P-131 - Percutaneous transhepatic cholangiographic drainage for malignanct biliary obstruction: single centre - 5 year experience

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Hepatobiliary Cancers
Palliative Care
Presenter S. Naheed
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors S. Naheed, E. Cowan, A. Higginson, R. Beable, M. Elms, C. Archer, A. O'Callaghan
  • Queen Alexandra Hospital, Portsmouth/UK

Abstract

Introduction

In the context of biliary obstruction secondary to malignancy, using percutaneous stenting techniques is well established in clinical practice where an endoscopic approach is not possible. Biliary stenting offers palliation in obstructive jaundice and optimisation of liver function to enable delivery of palliative chemotherapy. However, percutaneous stenting and drainage is not without risk with 30 day mortality rates being reported to be as high as 43%.1

Methods

We identified from radiology PACS system all PTC procedures with biliary drainage /stenting performed in patients with a malignant diagnosis over a five year period (January 2009 to December 2014) at our institution. For each case identified we reviewed patient data via MDT records and medical notes regarding diagnosis, treatment and outcome.

Results

45 patients (24 males, 21 females) with a mean age of 69years (range 41-90) underwent PTC with biliary drainage procedure. Cancer diagnoses were as follows: 19 Cholangiocarcinoma, 19 pancreatic, 3 colorectal, 3 oesophagogastric, 1 Duodenal. 26 patients (57%) had a single procedure only while 19 patients (42%) had more than one procedure (range 2 – 28).

30 day mortality following the first percutaneous intervention was 13.3% (6 patients), 5 of these 6 patients were aged 80 or over.

In the population aged 80 and over (11 patients) at first PTC, none received chemo or radiotherapy before or after PTC. The overall survival in this group was only 57.1 days - only 1 of this group of patients was alive at 6 months.

20 of the 45 patient cohort did not receive chemotherapy or radiotherapy either before or after PTC. Only 9 patients had had disease-modifying treatment prior to PTC whereas 22 patients went on to receive therapy afterwards.

1-year survival statistics following the first PTC are as follows: alive 17.8% (8), died 68.9% (31) - 1-year follow up has not been reached in 6 patients. Of the 8 patients alive at 1 year, 7 had received chemotherapy following biliary drainage.

Conclusion

Percutaneous biliary stenting/drainage remains a valuable tool to enable patients to receive palliative chemotherapy. Caution must be taken when considering PTC in the elderly population (80 and over) given the low likelihood of receiving further treatment and high mortality rates. It is reasonable to state that PTC is in most patients a poor prognostic indicator with a 1-year mortality of 68.9% - 30-day mortality alone is significantly high at 13.3% - but compares favourably to other published series from higher volume centres.

References

1 Sut M, Kennedy R, Mcnamee R et al. Long term results of percutaneous transhepatic cholangiographic drainage for palliation of malignant biliary obstruction. J Pall Med 2010: 13(11); 1311-1313.

2 https://www.ueg.eu/education/document-detail/?name=senior_discussion_reduces_mortality_following_percutaneous_transhepatic_cholangiography_a_12-month_prospective_audit&file=105643