Abstract
BackgroundPatients with advanced hepatocellular carcinoma (HCC) with jaundice have an extremely poor prognosis. Although biliary drainage can resolve obstructive jaundice, signs of obstruction may not be evident. This study evaluated the role of endoscopic biliary drainage in patients with advanced HCC and obstructive jaundice.MethodsFrom 2010 to 2015, 74 patients underwent endoscopic biliary drainage for obstructive jaundice due to advanced HCC. Jaundice resolution was defined as complete response and total bilirubin concentration below 3 mg/dl.ResultsThe technical success rate in the 74 patients was 92.1% (70/76). Of the 70 patients who underwent successful biliary drainage, 48 (68.6%) and 22 (31.4%) were Child-Pugh classes B and C, respectively, and 10 (14.3%) and 60 (85.7%) were BCLC stages B and C, respectively. Intrahepatic bile duct (IHD) dilatation was observed in 35 patients (50%). After drainage, the complete response rate was 35.7% (25/70). The mean time to resolution was 17.4 ±8.5 days. However, jaundice was re-aggravated in 74.3% (15/25) after a mean 103.5 ±96.4 days. Multivariate analysis showed that the absence of ascites, presence of IHD dilatation, normal range of prothrombin time, and lower MELD score were significantly associated with complete response. The overall survival rate was 15.7% (11/70) and the median survival time is 28 days (95% confidence interval 2.6–563 days). Complete response and HCC treatment after drainage were significantly associated with survival.ConclusionEffective endoscopic biliary drainage is an important palliative treatment in patients with advanced HCC and obstructive jaundice, especially those with IHD dilatation and preserved liver function, as determined by ascites, prothrombin time, and MELD score.
Highlights
Jaundice is encountered in 5–44% of patients with hepatocellular carcinoma (HCC) at the time of initial diagnosis and frequently occurs during the later stages of disease
This study evaluated the role of endoscopic biliary drainage in patients with advanced HCC and obstructive jaundice
Intrahepatic bile duct (IHD) dilatation was observed in 35 patients (50%)
Summary
Jaundice is encountered in 5–44% of patients with hepatocellular carcinoma (HCC) at the time of initial diagnosis and frequently occurs during the later stages of disease. Jaundice, which is associated with poor patient prognosis, is usually caused by diffuse tumor infiltration into the liver parenchyma, hilar invasion, and/or progressive terminal liver failure resulting from advanced underlying cirrhosis [1,2,3,4,5,6,7,8]. The cause of jaundice can affect patient prognosis [4]. Signs of obstruction are not evident in many patients with obstructive jaundice, due to cirrhosis or diffuse tumor infiltration. Patients with advanced hepatocellular carcinoma (HCC) with jaundice have an extremely poor prognosis. Biliary drainage can resolve obstructive jaundice, signs of obstruction may not be evident. This study evaluated the role of endoscopic biliary drainage in patients with advanced HCC and obstructive jaundice
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