Complications of Biliary Drainage in Patients with Malignant Biliary Obstruction.

Abstract

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. A retrospective study of patients who have undergone this procedure between 1 October 2011 and 31 December 2018 was carried out. 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. 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.