Complications of Biliary Drainage in Patients with Malignant Biliary Obstruction
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ORIGINAL RESEARCH
Complications of Biliary Drainage in Patients with Malignant Biliary Obstruction José António Ferraz Gonçalves 1 & Eugénia Rosendo 2 & Luciana Sousa 3 & Ana Rita Lopes 1 & Inês Leão 4 & Rita Queirós 5 & Sara Marote 6 & Maria José Sousa 1 Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Biliary tract obstruction in cancer patients is usually associated with a poor prognosis. The obstruction may cause distressing symptoms, such as pruritus. As this situation occurs mostly in advanced cancer, the primary objective of the treatment is in many cases symptom control and not prolonging life. However, some patients can be candidates for chemotherapy. To see the outcomes of stenting insertion in patients of our oncology center. Methods A retrospective study of patients who have undergone this procedure between 1 October 2011 and 31 December 2018 was carried out. Results Insertion of a biliary stent was performed in 171 patients. The most common diagnoses were gastric and colorectal cancers, each with 42 (24%), followed by pancreatic (34 (20%)) and biliary tract cancer (25 (14%)). Most stents (155 (91%)) were placed percutaneously. Complications were seen in 91 (53%) patients and the most common was cholangitis in 48 (53%) patients, and the median survival was 75.5 days (3–1246). A total of 168 (98%) patients were referred to palliative care. In a multivariable analysis, the ECOG performance status was associated with survival, with the ECOG 0, 1, and 2 associated with better survival and peritoneal metastases associated with lower survival. Conclusions For many patients with advanced cancers, it may not be clear if the benefits of palliative biliary stents outweigh the risks. Therefore, the problem should be discussed with the patients and their families, making clear the goals of care and the potential benefits and risks that can be expected. Keywords Malignant biliary obstruction . Biliary drainage . Biliary stent . Cholangitis
Introduction Malignant obstruction of the biliary ducts prevents the flow of bile toward the duodenum causing jaundice. The obstruction may result from biliary duct cancer or extrinsic compression
* José António Ferraz Gonçalves [email protected]; [email protected] 1
Palliative Care Service, Instituto Português de Oncologia, R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
2
Centro Hospitalar e Universitário do Porto, Porto, Portugal
3
Hospital de Braga, Braga, Portugal
4
Centro Hospitalar de Vila Nova de Gaia / Espinho, Espinho, Portugal
5
Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
6
Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
directly from another tumor, such as pancreas cancer, or from metastases like lymph nodes at the hepatic hilum. Although jaundice is the main sign of bile ducts obstruction, cholangitis and sepsis may also occur [1]. Malignant obstructive jaundice may have many consequences, such as pruritus, impairment
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