title: Obstructive jaundice in hepatocellular carcinoma: response after percutaneous transhepatic biliary drainage and prognostic factors.
abstract: OBJECTIVE
  To evaluate the therapeutic effect of percutaneous transhepatic biliary drainage (PTBD) in patients with obstructive jaundice caused by biliary involvement of hepatocellular carcinomas (HCC) and to determine the prognostic factors.
  
  
  METHODS
  We retrospectively analyzed the data of 22 consecutive patients (M:F = 20:2, mean age 52.8 years). Inclusion criteria were the patient having obstructive jaundice caused by HCC that invaded the bile ducts and having at least 4 weeks of follow-up data after the PTBD. We defined "good response" and "poor response" as whether the level of total bilirubin decreased more than 50% in 4 weeks or not. Total bilirubin level (T-bil), Child-Pugh score and the location of biliary obstruction for the two groups were compared. In addition, the interval between clinical onset of jaundice and PTBD, the degree of parenchymal atrophy and the size of the primary tumor were compared.
  
  
  RESULTS
  Of the 22 patients, 13 (59.1%) showed good response. T-bil was significantly lower in the good response group than in the poor (14.2 +/- 6 mg/dl vs 25.9 +/- 13.8 mg/dl, p =.017). In the five patients with T-bil <10 mg/dl, four (80%) showed good response, while in nine patients with T-bil > 20 mg/dl, only three (33%) showed good response. Although statistically not significant, patients with Child score <10 showed better results [good response rate of 66.7% (12/18)] than patients with Child score > or = 10 [good response rate of 25% (1/4)]. Involvement of secondary confluence of the bile duct also served as a poor prognostic factor (p = 0.235). The interval between clinical onset of jaundice and PTBD, the presence of parenchymal atrophy and the size of the tumor did not show significant effect.
  
  
  CONCLUSIONS
  Early and effective biliary drainage might be necessary in this group of patients with limited hepatic function.
authors.affiliation: Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Joon Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Tae Kyoung
authors.initials: TK
authors.lastname: Kim
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
authors.forename: Seong Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Ko
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Yoon
authors.forename: Kyung-Mo
authors.initials: KM
authors.lastname: Yeon
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology*; D002779:Cholestasis / Q000209:etiology* / Q000628:therapy*; D004322:Drainage; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies