Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction

Ann Surg Oncol. 2010 Sep;17(9):2303-11. doi: 10.1245/s10434-010-1045-9. Epub 2010 Apr 1.

Abstract

Background: Percutaneous biliary drainage (PBD) is used to relieve malignant bile duct obstruction (MBO) when endoscopic drainage is not feasible. Little is known about the effects of PBD on the quality of life (QoL) in patients with MBO. The aim of this study was to evaluate changes in QoL and pruritus after PBD and to explore the variables that impact these changes.

Materials and methods: Eligible patients reported their QoL and pruritus before and after PBD using the Functional Assessment of Cancer Therapy-Hepatobiliary instrument (FACT-HS) and the Visual Analog Scale for Pruritus (VASP). Instruments were completed preprocedure and at 1 and 4 weeks following PBD.

Results: A total of 109 (60 male/49 female) patients enrolled; 102 (94%) had unresectable disease. PBD was technically successful (hepatic ducts cannulated at the conclusion of procedure) in all patients. There were 2 procedure-related deaths. All-cause mortality was 10% (N = 11) at 4 weeks and 28% (N = 31) at 8 weeks post-PBD with a median survival of 4.74 months. The mean FACT-HS scores declined significantly (P < .01) over time (101.3, 94.8, 94.7 at baseline, 1 week, 4 weeks, respectively). The VASP scores showed significant improvement at 1 week with continued improvement at 4 weeks (P < .01).

Conclusions: PBD improves pruritus but not QoL in patients with MBO and advanced malignancy. There is high early mortality in this population.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bile Duct Neoplasms / complications
  • Bile Duct Neoplasms / pathology
  • Bile Duct Neoplasms / therapy
  • Cholangiocarcinoma / complications
  • Cholangiocarcinoma / pathology
  • Cholangiocarcinoma / therapy
  • Cholestasis / pathology
  • Cholestasis / surgery*
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / secondary
  • Colorectal Neoplasms / therapy
  • Drainage*
  • Female
  • Follow-Up Studies
  • Gallbladder Neoplasms / complications
  • Gallbladder Neoplasms / pathology
  • Gallbladder Neoplasms / therapy
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Palliative Care*
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy
  • Prospective Studies
  • Quality of Life*
  • Survival Rate
  • Treatment Outcome
  • Young Adult