Obstructive jaundice in hepatocellular carcinoma: response after percutaneous transhepatic biliary drainage and prognostic factors.
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.
Lee
Joon Woo
JW
Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Korea.
Han
Joon Koo
JK
Kim
Tae Kyoung
TK
Choi
Byung Ihn
BI
Park
Seong Ho
SH
Ko
Young Hwan
YH
Yoon
Chang Jin
CJ
Yeon
Kyung-Mo
KM
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