Clinical outcomes and prediction of survival following percutaneous biliary drainage for malignant obstructive jaundice

Abstract

The present study aimed to investigate the clinical outcomes of percutaneous transhepatic biliary drainage in patients with obstructive jaundice and identify potential predictors of patient survival. Clinical data from 102 patients (66 males and 36 females; median age, 63.50 years; range, 29–84 years) with a mean (± standard deviation) pre-drainage serum bilirubin level of 285.4 (±136.7 μmol/l), were retrospectively studied. Technical and clinical success, complications and survival time were recorded and their relationship with clinical factors, including age, obstruction level, liver metastases, serum bilirubin level and subsequent treatments following drainage, were analyzed by Fisher’s exact test. Patient survival rate and other predictors were analyzed by Kaplan-Meier survival curves and Cox’s proportional hazard model. The technical and clinical success rates were 100 and 76.5%, respectively. The presence of liver metastases was associated with reduced successful drainage. The overall complication rate was 7.8% and the overall median survival time was 185 days [95% confidence interval (CI), 159–211 days]. A log-rank test showed that age (χ2, 4.003; P=0.04), bilirubin levels following procedure (χ2, 5.139; P=0.02) and subsequent therapy (χ2, 15.459; P=0.00) affected survival time. However, Cox’s regression analysis revealed no administration of additional treatments to be a risk factor of survival (odds ratio, 2.323; 95% CI, 1.465–3.685; P=0.000). Percutaneous transhepatic biliary drainage for malignant biliary obstruction was found to be a safe and effective method to relieve jaundice caused by progressive neoplasms. Subsequent radical therapy following drainage, including surgery, chemotherapy and other local treatment types, are likely to increase patient survival.

Prediction of survival following percutaneous biliary drainage for malignant biliary obstruction

“…[11] In another study, Zhang et al patients who received additional treatments (chemotherapy, palliative surgery and other local types) exhibited a significantly longer survival time of 285 days (95% CI, 218 352 days) compared with 150 days (95% CI, 123 177 days) for those without subsequent treatment. [13] However, in a retrospective study with 18 patients by Iwasaki et al, the median survival rate after PTBD was 59, with only two patients receiving chemotherapy after the procedure. [25] In our study, the median total bilirubin level before the intervention was 15.01mg/dL, which dropped to 6.4 mg/dL after the intervention (P < 0.01).…”

“…[23] For this reason, few studies investigated the prognostic factors that predict short survival time in these patients. [11,13,19,23] By identifying poor predictive survival factors, we believe that through pre-PTBD clinical, radiological, and laboratory data analysis, we can identify the population of patients for whom PTBD will not increase well-being or survival, and in return, such invasive procedure can be avoided. In this study, we aimed to address two main issues: the survival of patients with malignant biliary obstruction post percutaneous drainage; and to describe the prognostic factors that predict short survival time after percutaneous biliary drainage.…”

“…Other studies reported increase survival time after chemotherapy administration post percutaneous biliary drainage. [13] For example, Kasuga et al divided the patients in their cohort into three groups. The median survival rate was 273 days for patients who had successful chemotherapy after undergoing PTBD, 65 days for patients who had undergone successful percutaneous transhepatic biliary drainage without receiving subsequent chemotherapy and 34 days in the remaining patients who had undergone unsuccessful percutaneous transhepatic.…”

“…[11,12] PTBD was shown to be effective in reducing the serum bilirubin level to a degree that patients could receive additional chemotherapy. [13] In other patients where chemotherapy cannot be offered, PTBD may have a palliative value in relieving biliary obstruction. PTBD was shown in a prospective study done by Robson et al to significantly reduce the severity of pruritus.…”

“…[15,17,18] Factors able to predict the long and short term survival after PTBD are scarcely reported in the medical literature and have not yet been well established. [13] In this study, we aimed to find prognostic factors of short term survival after PTBD in cancer patients; in addition, we aimed to evaluate the effectiveness of this procedure during the last month of life.…”