Unresectable malignant biliary obstruction confers a poor prognosis. Drainage of the biliary system with percutaneous trans-hepatic biliary drainage (PTBD) is offered with the intent of palliation of symptoms or to enable SACT (systemic anti-cancer treatment) but is associated with significant morbidity and mortality. Repeat PTBD for oncology patients was reviewed, asessing factors associated with poor outcomes to improve patient selection for PTBD.
Retrospective study of patients undergoing repeat PTBD at University Hospital Coventry & Warwickshire between 2015-2020. By collating data from the hospital database, morbidity and mortality of a repeat PTBD was reviewed, and factors associated with increased mortality noted.
27 cases of repeat PTBD for recurrent malignant biliary obstruction were identified and analysed out of a total of 211 PTBD procedures performed for malignant biliary obstruction. Median survival was 81 days (range 22-455), median length of stay 15 days (range 2-52), and median age 66 (range 34-81). Mortality: in hospital was 3.7%, 7 day 0%, 30 day 7.4% and 90 day 48%. Factors associated with lower median survival rates were: male gender, age > 65, receiving SACT (either before or after PTBD), complications of post procedure sepsis and a pre-procedure bilirubin of greater than 100 umols/L. Patients receiving SACT within 3 months prior to PTBD had better median survival compared to those who had SACT > 3 months prior (90 days vs 72). SACT following PTBD had the highest median survival (278 days). Comparatively, cases receiving no chemotherapy (pre or post PTBD) had the lowest median survival (69 days) Median survival following PTBD (days)
Female Male 110 68 Age <65 Age 65+ 96 81 SACT No SACT 91 69 No sepsis Sepsis 103 75 Bilirubin <100umol/L Bilirubin >100umol/L 96 83
Post procedure sepsis reduced median survival and increased median length of stay from 10 to 17 days.
Repeat PTBD in this cohort of patients showed a similar median survival to those undergoing first episode of PTBD (81 vs 88 days respectively). Features associated with better outcomes that could potentially guide patient selection include: lower age, female gender, lower bilirubin pre-procedure and being on active SACT or progressing to SACT post procedure.
The authors.
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All authors have declared no conflicts of interest.