P-146 - Stenting metastatic bile duct obstruction (BDO): the importance of liver function parameters

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Hepatobiliary Cancers
Palliative Care
Surgery and/or Radiotherapy of Cancer
Presenter M. Bergamino Sirven
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors M. Bergamino Sirven1, M. Galán2, R. Montal3, J. Gornals Soler4, E. Escalante Porrua5, V. Navarro Perez6, M. Marin Melia7
  • 1Institut Català d'Oncologia (Hospital Duran y Reynals), Hospitalet del Llobregat/ES
  • 2Interdisciplinary Committee Of Esophagogastric Tumours, Institut Català D'oncologia (ico), Hospitalet de Llobregat, Llobregat/ES
  • 3Institut Català d'Oncologia-IDIBELL, L'Hospitalet de Llobregat/ES
  • 4Hospital de Bellvitge, Hospitalet del Llobregat/ES
  • 5Hospitalet del Llobregat, Hospitalet del Llobregat/ES
  • 6Departament d'Estadística- IDIBELL, Hospitalet del Llobregat/ES
  • 7Oncology Hospitalization Unit-Institut Català d'Oncologia (Hospital Duran i Reynalds), Hospitalet del Llobregat/ES

Abstract

Introduction

Malignant BDO is a common clinical entity. Usually, it produces deterioration of the patient's quality of life because of symptoms such as jaundice, pruritus or pain. When the primary pancreatobiliary cancers are the etiology of this obstruction, intervention to decompress the biliary tract is often performed. However, when the cause of obstruction is a metastatic disease the survival is usually worse and the outcomes after stenting are mixed, with no clear validated predictors. The purpose of this study was to evaluate the benefit of stenting the BDO caused by metastases in this palliative setting.

Methods

We designed a retrospective study of 55 patients who consecutively, underwent biliary stenting due to a metastatic BDO from 2010 to 2014 in Hospital de Bellvitge - Institut Català d'Oncologia. Data collected were; type of primary tumor, burden of the disease, cause of obstruction, Performance-Status, symptoms and blood tests previous and after intervention, methods and types of stenting, complications of the procedure, if chemotherapy could be done after stenting, dates and causes of death.

Results

Colorectal cancer was the most common primary tumor (49%), over gastric cancer (26%) and others (25%). Metastatic disease was mainly in the liver, lymph nodes, peritoneum and lungs (62%, 56%, 36% and 31% respectively). Up to 76% of patients had been treated with chemotherapy in the metastatic setting before the obstruction. The obstruction was caused by hilar lymph nodes (52%), liver metastases (40%), peritoneal metastases (4%) and endobiliary metastases (4%).

Percutaneous transhepatic cholangiography was the most used technique (90%), being the endoscopic retrograde cholangiopancreatography less used (10%), probably because of the majority of upper obstructions of the bile duct. Type of stent used was metal for 54% and plastic or just external drainage for 46%, observing significant differences in survival (p-value 0,018, HR: 0,50).

During the first two weeks, 5% of patients died and 33% suffered severe complications (18% bacteriemia and 15% hemobilia) without differences between types of stenting. Of the patients that suffered jaundice, 71% improved after the procedure. Similarly, 78% improved pruritus. Bilirubin levels decreased in 84% of patients. Of note, 44% of patients needed re-stenting at some point. 33% of patients were able to receive one or more lines of chemotherapy. Median overall survival of all patients was 2.3 months (CI 95% 0.5-4.1).

When we compared 16 patients that lived less than 1 month with 16 patients that lived more than 5 months we detected significant differences regarding cholestasis parameters before the stenting (p-value: 0,037, HR: 0,032). Mean prothrombin time, bilirubin (umol/l) and albumin (g/l) were 1.58, 280 and 29 respectively in the group of poor prognosis, compared with 1.06, 177 and 32 respectively in the group of good prognosis.

Conclusion

The biliary tract drainage improves symptoms and the cholestasis parameters in most of patients with metastatic BDO. On the other hand, a high number of them suffer early and late complications related to this palliative procedure. Algorithms with liver function parameters before stenting (prothrombin time, bilirubin and albumin) could help the decision-making to perform this invasive procedure in patients that usually have poor survival.