The Clinical Benefit of Percutaneous Transhepatic Biliary Drainage for Malignant Biliary Tract Obstruction

SIMPLE SUMMARY: Percutaneous transhepatic biliary drainage (PTBD) has been widely employed as a biliary decompression procedure for malignant proximal biliary obstruction. Patients underwent PTBD procedures of jaundice caused by malignant disease for restarting chemotherapy or palliative intent. Clinical outcomes following PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed to restart chemotherapy, are presented in this analysis. Median survival time following the PTBD was 9 weeks, but in patients with ABD who received chemotherapy it was 64 weeks. Patients with the longest survival rate were in good performance status (ECOG 0–1) and lower bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels at the time of the procedures. Improving quality of life is a major goal in this palliative treatment, but we really need to assess the potential benefits and risks and determine how to select patients who would have positive outcome for this procedure. ABSTRACT: Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan–Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0–1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.