3:48 PM, Abstract No. 69 - Percutaneous biliary drainage catheter insertion in advanced hepatic metastatic disease

Abstract

Patients with extensive metastatic hepatic tumor burden may be questionable candidates for percutaneous transhepatic biliary drainage (PBD) insertion due to concern for traversing tumor, a presumed dismal prognosis, compromised hepatic function as a contributor to hyperbilirubinemia, and multifocality of biliary ductal obstruction. The purpose of this study was to analyze outcomes of percutaneous biliary drainage (PBD) catheters in patients with advanced hepatic metastatic disease. Retrospective review of our procedural database was performed to identify patients undergoing PBD catheter insertion for the indication of hyperbilirubinemia and imaging-confirmed biliary dilation in the setting of severe multifocal hepatic metastatic disease (greater than 20% volume replacement) over a 7.5 year period. A total of 44 patients (24 males, mean age 57.4 years, range 34-80 years) were included for analysis. Periprocedural cross-sectional imaging was used to assess hepatic metastatic disease burden and location of PBD catheters. Complications, serum alkaline phosphatase (AP), and total bilirubin (TB) values were also investigated. PBD insertion was performed in 44 patients with severe hepatic metastatic disease burden. Colorectal (n=16) and pancreatic metastases (n=9) were most common. The serum total bilirubin decreased by at least 10% in 68% of patients. Of these patients, the mean decrease in bilirubin levels was 4.5±2.7mg/dL (42%±20%). Only 6% demonstrated normalization of bilirubin levels (less than 2 mg/dL). The median survival was 29 days (95% CI 15-43 days). Of 14 patients with a post-PBD insertion CT scan, in 11 patients (79%), the PBD traversed tumoral tissue prior to entering the biliary tree. Two patients required blood transfusions due to periprocedural blood loss without need for additional interventions. One patient re-presented with persistent pericatheter leakage. While the majority of patients demonstrated decreased serum bilirubin levels, normalization was rare and prognosis is dismal. PBD catheter traversal of hepatic tumors demonstrated a low incidence of significant hemorrhage or pericatheter leakage.