Combined percutaneous–endoscopic stenting of malignant biliary obstruction: results from 106 consecutive procedures and identification of factors associated with adverse outcome

Neal, Christopher P.; Thomasset, Sarah; Bools, D; Sutton, Christopher; Garcea, Giuseppe; Mann, Christopher D.; McDermott, Yvonne; Newland, C. J.; Robinson, Richard; Dennison, Ashley R.; Berry, David P.

doi:10.1007/s00464-009-0586-0

Cited by 27 publications

(34 citation statements)

References 26 publications

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“…Our findings did not support the increased 30-day mortality with PTBD, and in fact, we found a lower incidence of 30-day mortality in PTBD patients compared with ERCP patients (0 vs. 6.3 %, respectively). These contrasting results are likely a result of improved imaging, procedural and surgical techniques over the past three decades; a 30-day mortality of 15 % with endoscopic stent placement and 30 % following percutaneous stent placement would be considered high by today's standards [13–15]. Speer et al [10] also assessed only short-term outcomes between the different methods of biliary drainage and did not assess whether PTBD patients had different rates of metastases or late-mortality compared with ERCP patients.…”

Section: Discussionmentioning

confidence: 99%

“…While PTBD has been shown to improve pruritus symptoms, there is no improvement in patient's quality of life and PTBD potentially establishes a pancreaticodermal tract allowing for tumor cell seeding that can lead to recurrences [10–12]. Despite the controversy surrounding percutaneous drainage, PTBD is often performed in the event of ERCP failure [13]. We sought to evaluate whether PTBD in resectable pancreatic cancer patients influences hepatic recurrence rates and overall survival.…”

Section: Introductionmentioning

confidence: 99%

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Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage

et al. 2015

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Background We evaluated whether preoperative biliary drainage was predictive of recurrence and survival among patients with resectable pancreatic cancer. Methods Patients with pancreatic cancer who were treated with upfront surgery between 2000 and 2012 were identified and stratified by preoperative percutaneous transhepatic cholangiogram-guided drainage (PTBD), placement of endoscopic stents (ERCP), or no biliary drainage (NBD). The primary endpoint was overall survival. Results We identified 193 patients with resectable pancreatic head cancer (33 PTBD; 96 ERCP; and 64 NBD). Key differences between the three groups were more patients who underwent >1 preoperative biliary procedures (p = 0.004) in the PTBD cohort. PTBD patients had a significant increase in hepatic recurrence rate compared with patients who did not undergo PTBD (44.8 vs. 23.3 %, p = 0.02). PTBD patients also had worse overall survival. Median and 5-year survival for PTBD, ERCP, and NBD patients were 17.5 months and 3 %, 22.4 months and 24 %, and 28.9 months and 32 %, respectively (p = 0.002). MVA revealed that percutaneous drainage was an independent predictor of worse overall survival [HR 1.76, 95 % CI (1.05–2.99), p = 0.03]. Conclusions Patients with resectable pancreatic cancer who receive PTBD have more advanced disease, higher hepatic recurrence, and worse survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage

et al. 2015

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“…However, to our knowledge, the factors that may affect the ability of a malignant biliary obstruction to be crossed have not been discussed in detail in the existing literature (1)(2)(3)(4)(5)(6)(7)(8). In the studies of Neal et al (9) and Dowsett et al (10), the ability of biliary strictures to be traversed was found to be unrelated to stricture type or location. However, in these studies, combined endoscopic and percutaneous approaches were used.…”

Section: Discussionmentioning

confidence: 97%

“…Crossing the obstruction cannot always be achieved easily. Failure to traverse biliary strictures has been found to be unrelated to the stricture type or location in previous studies (9,10). Mueller et al reported that the likelihood of successful stricture recanalization could not be predicted based on the initial cholangiographic appearance (11).…”

mentioning

confidence: 99%

Percutaneous management of malignant biliary disease: factors that influence ability to overcome the stricture.

Küçükay

Rs²,

Yurdakul³

et al. 2010

Diagn Interv Radiol

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“…In fact, even according to the indications of the latest guidelines issued by the major scientific societies that worked on this topic, the implantation of this kind of stent is recommended, when life expectancy exceeds 6 months. 1,2,9 This was reasonable at the time of the implantation, since the patient could be reasonably benefit from a combined chemotherapy treatment, which, according to the literature, might have offered a further 3-4 month survival.…”

Section: Placement Of Metallic Stent For Final Palliationmentioning

confidence: 99%

Inappropriateness in biliary stenting

2013

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Starting from a real case of a 69-year old patient affected by cholangiocarcinoma, we intend to discuss the accuracy and appropriateness of the diagnostic and therapeutic procedures adopted. This case shows in particular that a more accurate preoperative staging could probably avoid the patient unnecessary laparotomy. According to the indications in the medical literature, this patient could possibly benefit from chemotherapy, but a chemoembolization of liver metastases was performed. However in the literature no available evidence suggests that this treatment would be beneficial in this kind of clinical picture. Eventually, when the disease was already at an advanced stage and worsened due to a necrosis of the left hepatic lobe and a cholangitic infection, a repositioning of the stent on the stent was performed, despite in the literature the life expectancy cut-off for this procedure is at least 6 months. We also discuss the communication between the physician, the patient and the family, which was probably based on overly optimistic and unrealistic expectations. This led to a number of surgical procedures, which were not certainly helpful and indeed were probably even harmful for this patient. In addition, these procedures caused unnecessary costs borne by the healthcare system. In conclusion, we advocate that discussion and self-assessment must be always promoted, so that the healthcare professionals can review the process and the outcome of their treatment as well as their behavior to understand if it could have been more appropriate to offer actual benefits to the patients in terms of better quality of life and longer life expectancy.

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Combined percutaneous–endoscopic stenting of malignant biliary obstruction: results from 106 consecutive procedures and identification of factors associated with adverse outcome

Cited by 27 publications

References 26 publications

Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage

Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage

Percutaneous management of malignant biliary disease: factors that influence ability to overcome the stricture.

Inappropriateness in biliary stenting

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