Percutaneous drainage is useful in biliary obstruction due to metastatic colorectal cancer

Abstract

Jaundice due to malignant biliary obstruction impacts quality of life and limits therapeutic options. Percutaneous biliary drainage (PBD) is an effective way to reduce serum bilirubin levels and itching in patients (pts) with malignant biliary obstruction. We evaluated the efficacy of PBD in jaundiced pts with metastatic colorectal cancer (CRe). Methods: Pts with biliary obstruction due to CRC were selected for PBD at our multidisciplinary conference. Charts of those pts who had PBD between April, 1996 and September, 1999 were reviewed. Additional information was obtained by telephone interviews. Data collected included: age, pruritis, use of chemotherapy, date of initial and subsequent PBDs, anatomic level of biliary obstruction, pre and post PBD bilirubin levels, PBD complications, and median survival. Statistical analysis was performed by Chi-square testing. Results: 44 pts had 63 PBDs; 13 pts required 2 PBDs and I pt required 3 PBDs for adequate drainage of liver segments. Median age was 64 years (32-82). 9 pts had biliary sclerosis due to hepatic artery infusional (HAl) chemotherapy (21%). 35 pts had biliary obstruction due to metastatic CRe. Pruritis was present in 29 pts and was improved by PBD in 25 (86%, p<0.05). The level of biliary obstruction was at the hilus in 9 pts, common hepatic duct in 29 pts, and common bile duct in 3 pts. Median bilirubin level improved from 17.8mg/dl (1.3-40.8) to 3.2mg/dl (0.5-15.4) after PBD, with an average decrease of 13.2 mg/dl. In 7 HAl pts and 11 metastatic CRC pts, bilirubin levels normalized to 1.5mg/dl or less. Pts with HAl biliary sclerosis and malignant biliary obstruction responded similarly to PBD. Initial polyethylene stents were replaced by Wallstents in 34 pts (77%). Early complications of bleeding (n=2) and sepsis (n=I) occurred in 3/44 pts (6.7%). One bleeding episode required hepatic artery embolizations and blood transfusions; the other did not require intervention. Late complications included clogging in 10/34 Wallstents (29%), requiring repeat intervention. Median survival was 4.5 months after the initial PBD. There was no PBD associated mortality. Conclusions: In selected pts with biliary obstruction due to metastatic CRC, PBD can normalize serum bilirubin and relieve pruritus in the majority. In skilled hands, PBD is a safe procedure in pts with metastatic CRe. By lowering serum bilirubin, treatment is possible with hepatically metabolized drugs such as CPT-II. Jaundiced pts with biliary obstruction due to metastatic CRC can benefit from PBD.