Clinical outcomes of biliary drainage of malignant biliary obstruction due to colorectal cancer metastases: A systematic review

Abstract

Background and aims: Malignant biliary obstruction is an ominous complication of metastatic colorectal cancer (mCRC). Biliary drainage is frequently performed to relieve symptoms of jaundice or enable palliative systemic therapy, but effective drainage can be difficult to accomplish. The aim of this study is to summarize literature on clinical outcomes of biliary drainage in mCRC patients with malignant biliary obstruction. Methods: We searched Medline and EMBASE for studies that included patients with malignant biliary obstruction secondary to mCRC, treated with endoscopic and/or percutaneous biliary drainage. We summarized available data on technical success, clinical success, adverse events, systemic therapy administration and survival after biliary drainage. Results: After screening 3584 references and assessing 509 full-text articles, seven cohort studies were included. In these studies, rates of technical success, clinical success and adverse events varied between 63%-94%, 42%-81%, and 19%-39%, respectively. Subsequent chemotherapy was administered in 17%-56% of patients. Overall survival varied between 40 and 122 days across studies (278-365 days in patients who received subsequent chemotherapy, 42-61 days in patients who did not). Conclusions: Successful biliary drainage in mCRC patients can be challenging to achieve and is frequently associated with adverse events. Overall survival after biliary drainage is limited, but is significantly longer in patients treated with subsequent systemic therapy. Expected benefits of biliary drainage should be carefully weighed against its risks.

[Retracted] Value of Multislice Spiral CT in Differential Diagnosis of Thick‐Wall Gallbladder Carcinoma and Chronic Cholecystitis

“…Bile duct dilation is an indirect sign of gallbladder cancer, which is triggered by bile duct compression, tumor invasion of the common bile duct, and tumor spread through the bile duct [ 14 ]. Low biliary tract obstruction is caused by bile duct dilation causing stones to enter the lower common bile duct, and high biliary tract obstruction is caused by Mirizzi syndrome [ 15 , 16 ]. Patients with chronic cholecystitis are less likely to have high or low obstruction because of the absence of bile duct dilation.…”

Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Obstruction in Advanced Solid Organ Malignancy: Clinical Outcomes and a Perspective on Quality of Life

“…Two notable studies have examined readmission data post-PTBD. One reported a 30-day readmission rate of 20.8% and a median length of stay of nine days [9]. Another study reported a mean length of stay of 16.6 days post-PTBD [10].…”

Impact of cholangitis on survival of patients with malignant biliary obstruction treated with percutaneous transhepatic biliary drainage

“…Receiving chemotherapy after successful biliary drainage has a positive impact on survival after PTBD [6,7,32]. There are studies in which chemotherapy has been administered for 14-52% of gastrointestinal cancer patients after successful PTBD [21,25,[33][34][35]. In one of these studies, the incidence of cholangitis was reported [25].…”