Interventional Radiology and the Care of the Oncology Patient

Abstract

Interventional Radiology (IR) is occupying an increasingly prominent role in the care of patients with cancer, with involvement from initial diagnosis, right through to minimally invasive treatment of the malignancy and its complications. Adequate diagnostic samples can be obtained under image guidance by percutaneous biopsy and needle aspiration in an accurate and minimally invasive manner. IR techniques may be used to place central venous access devices with well-established safety and efficacy. Therapeutic applications of IR in the oncology patient include local tumour treatments such as transarterial chemo-embolisation and radiofrequency ablation, as well as management of complications of malignancy such as pain, organ obstruction, and venous thrombosis.

A review of percutaneous transhepatic biliary drainage at a tertiary referral centre

“…8,13 Furthermore, in some studies the incidence of cholangitis in patients with underlying malignancy has been shown to be approximately 50% in total; in particular, it is twice as common in those with internal and external drainage than in those with external drainage alone. 2,22 In addition, it has been shown that the longer the duration of PBD, the more likely the patient is to develop cholangitis. 2,23 Infected bile has been detected in 25% to 36% of patients with malignant biliary obstruction, 24 making pre-procedural administration of appropriate prophylactic antibiotics to this group of patients even more important; and overall, prophylactic antibiotic, including cover for Escherichia coli, Klebsiella, Enterococcus, Streptococcus, Enterobacter and Pseudomonas aeruginosa, is strongly recommended for all patients prior to biliary procedures, to minimise the risk of potential septic complications.…”

“…2,22 In addition, it has been shown that the longer the duration of PBD, the more likely the patient is to develop cholangitis. 2,23 Infected bile has been detected in 25% to 36% of patients with malignant biliary obstruction, 24 making pre-procedural administration of appropriate prophylactic antibiotics to this group of patients even more important; and overall, prophylactic antibiotic, including cover for Escherichia coli, Klebsiella, Enterococcus, Streptococcus, Enterobacter and Pseudomonas aeruginosa, is strongly recommended for all patients prior to biliary procedures, to minimise the risk of potential septic complications. 2,10 Previously recommended prophylaxis regimens included ampicillin and gentamycin or cefotetan and mezocillin 25 ; however, in Beaumont Hospital, the prophylactic antibiotic of choice is monotherapy with piperacillin/tazobactam (Tazocin, Pfizer, Cork, Ireland), which is a broad-spectrum antibiotic that has Gram-negative, Gram-positive, and aerobic coverage, and importantly, high levels of biliary excretion.…”

“…4e7 A great majority of patients with biliary obstruction, in particular due to pancreatic neoplasms or stone disease, can be treated by endoscopic retrograde cholangiopancreatography (ERCP); however, those who fail ERCP, may require percutaneous transhepatic biliary drainage (PTBD) to achieve adequate biliary decompression. 1,2 PTBD is an effective method for the management of biliary abnormalities under imaging guidance using interventional radiology techniques, which involves sterile cannulation of a peripheral bile duct followed by guidewire and catheter positioning above the stricture. 8,9 Subsequently, contrast material injection into an intra-hepatic bile duct will provide a cholangiogram, delineating the anatomy of the biliary tree, determining the location of obstruction, and helping to guide the intervention.…”

“…8,9 Subsequently, contrast material injection into an intra-hepatic bile duct will provide a cholangiogram, delineating the anatomy of the biliary tree, determining the location of obstruction, and helping to guide the intervention. 2,9 Depending on the cholangiographic findings, placement of a catheter or stent may be considered to facilitate internal or external drainage of bile, allowing decompression of the biliary system. 1,2,10 Apart from the primary underlying cause and the level of the biliary obstruction, different technical aspects of the interventional procedure, including the access, internal versus external biliary drainage, position and type of stent, tract embolisation and duration of drainage have all been investigated as factors that may influence the outcome of the percutaneous biliary drainage (PBD).…”

“…2,9 Depending on the cholangiographic findings, placement of a catheter or stent may be considered to facilitate internal or external drainage of bile, allowing decompression of the biliary system. 1,2,10 Apart from the primary underlying cause and the level of the biliary obstruction, different technical aspects of the interventional procedure, including the access, internal versus external biliary drainage, position and type of stent, tract embolisation and duration of drainage have all been investigated as factors that may influence the outcome of the percutaneous biliary drainage (PBD). 11 PTBD is effective at relieving biliary obstruction; however, it has been associated with complications including sepsis, haemorrhage and localised infective, as well as inflammatory processes such as abscess, peritonitis, cholecystitis, and pancreatitis, 2,12 with an overall 30-day in hospital mortality rate of approximately 20% in one recent study.…”