Malignant biliary obstruction and percutaneous transhepatic biliary drainage – the impact of cholangitis and chemotherapy on survival

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Oulu University Hospital, Lecture hall 1, Kajaanintie 50, Oulu

Topic of the dissertation

Malignant biliary obstruction and percutaneous transhepatic biliary drainage – the impact of cholangitis and chemotherapy on survival

Doctoral candidate

Licentiate of Medicine Jarmo Niemelä

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, University of Oulu Graduate School, Medical Research Center Oulu

Subject of study

Medicine

Opponent

Professor Juha Grönroos, Turku University Hospital

Custos

Professor Juha Saarnio, Oulu University Hospital

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Malignant biliary obstruction and percutaneous transhepatic biliary drainage – the impact of cholangitis and chemotherapy on survival

The purpose of this retrospective study was to clarify the challenging treatment of the patients with malignant biliary obstruction treated with percutaneous transhepatic biliary drainage (PTBD) in a large series of real-life clinical practice. This study consists of all patients who were treated with PTBD for malignant biliary obstruction between 1999 and 2016 at the Oulu University Hospital. Among 643 patients, 258 (40.1%) had pancreatic cancer, 222 (34.5%) had biliary tract cancer, 52 (8.1%) had gastric cancer, 43 (6.7%) had colorectal cancer and 68 (10.6%) had other cancers. This thesis consists of three studies.
Study I evaluated the survival and predictive factors for outcomes of all the patients in this cohort. Patients had a poor prognosis with an overall median survival of 2.6 months after PTBD. Independent factors predicting poor outcome were metastatic cancer, Eastern Cooperative Oncology Group performance status (ECOG PS) >2, American Society of Anesthesiologists (ASA) class 4, and bilirubin level after PTBD ≥60.0 µmol/L.
Study II evaluated the impact of cholangitis on survival in 588 patients with gastrointestinal cancer: 158 patients with cholangitis before PTBD had poorer survival (1.8 months) than 215 patients with cholangitis after PTBD (3.0 months).
Study III evaluated the survival benefit of chemotherapy compared to best supportive care after PTBD for patients with pancreatic or biliary tract cancer: 32 patients with pancreatic or biliary tract cancer that received chemotherapy showed significantly better survival (11.7 months) than 126 patients that received only the best supportive care (1.7 months).
Patients with cancer and biliary obstruction treated with PTBD have a poor prognosis.
The results of this study highlight a systematic need for oncologic evaluation of patients after PTBD, because chemotherapy after PTBD was associated with several months of survival benefit compared to patients with only best supportive care. Treatment of cholangitis with biliary drainage in addition to antimicrobial treatment is crucial for improving survival. The found predictive factors (metastatic cancer, ECOG PS, ASA class, cholangitis, and bilirubin level after drainage) should be taken into account when a multidisciplinary team evaluate appropriate treatment for these challenging patients.
Last updated: 6.5.2022