title: Changing attitudes in the palliation of proximal malignant biliary obstruction.
abstract: The majority of patients with malignant hilar obstruction have an unresectable tumor. Thus an effective palliation of obstructive jaundice is the main therapeutic goal and can be achieved by either surgical or non-surgical procedures. One hundred twenty-nine consecutive patients with proximal biliary stricture, admitted to our institution, were retrospectively reviewed. Thirty patients underwent surgical bypass, with 30-day mortality and morbidity rates of 10% and 23%, respectively. Median survival time was 41 weeks. Twenty-six patients were treated by percutaneous stenting, with 30-day mortality and morbidity rates of 15% and 19%, respectively. Median survival time was 19 weeks. Endoscopic palliation was performed in 73 patients, with 30-day mortality and morbidity rates of 5% and 18%, respectively. Median survival time was 27 weeks. Although the differences among the three groups of patients were not statistically significant, a lower morbidity rate in patients treated by endoscopic stenting was shown.
authors.affiliation: Department of General Surgery I, Catholic University of Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Magistrelli
authors.forename: R
authors.initials: R
authors.lastname: Masetti
authors.forename: R
authors.initials: R
authors.lastname: Coppola
authors.forename: C
authors.initials: C
authors.lastname: Coco
authors.forename: A
authors.initials: A
authors.lastname: Antinori
authors.forename: G
authors.initials: G
authors.lastname: Nuzzo
authors.forename: A
authors.initials: A
authors.lastname: Picciocchi
mesh_terms: D002759:Adenoma, Bile Duct / Q000150:complications; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001650:Bile Duct Neoplasms / Q000150:complications*; D001652:Bile Ducts / Q000601:surgery; D001651:Cholestasis, Extrahepatic / Q000209:etiology* / Q000601:surgery*; D016145:Endoscopy, Digestive System; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D019736:Prostheses and Implants; D012189:Retrospective Studies; D015607:Stents