Percutaneous biliary drainage in malign obstructive jaundice: Is it really necessary for all patients with malign obstructive jaundice?

Background

Malign obstructive jaundice (MOJ) in cancer is due to liver metastasis and/or biliary duct compression. Percutaneous biliary drainage (PBD) is a palliative procedure. Prognostic & predictive factors are needed for selection of the cancer patients who will get more benefit from PBD in MOJ. We evaluated cancer patients (CP) who had PBD for MOJ for clinicopathological features (CPF) & survival outcomes besides potential predictive markers for PBD.

Methods

110 CP who had PBD for MOJ between 2010 & 2016 were evaluated retrospectively. The correlation between biochemical values, CPF (extrahepatic metastasis (EM), obstruction cause (OC), stent localization) & total bilirubin (TB) was evaluated by ROC analysis. The CP were analyzed according to TB after PBD [groups A: normal (1 mg/dl or 20% decrease), C: stable/increase.

Results

Median age was 60 (28-82) years. 57 were male. In univariate analysis, EM & OC were significant factors with concordance to biochemical values. Albumin (p = 0.007, OR: 5.2, 1,5-17,1), LDH (p = 0.041, OR:2.5, 1.02-6,2) & OC (p = 0.019, OR:3.4, 1.2-9,9) remained significant in multivariate analysis. The CP were grouped according to these risk factors (RF): groups 1 (22,7%: no RF), 2 (64,5%: 1-2 RF), 3 (12,7%: >3 RF). TB normalization & OS after PBD are shown in table 1. Stenting proximal to choledoc had better TB normalization (44,7% vs 17,6%, p = 0.006).Chemotherapy rates were as 60% for group A, 36,8% for group B & 21,9% for group C (p = 0.004). 6-months OS was 41,3% for patients receiving chemotherapy & 17,7% for others (p 

Conclusions