[Treatment of malignant biliary occlusion by means of transhepatic percutaneous biliary drainage with insertion of metal stents--results of an 8-year follow-up and analysis of the prognostic parameters].
OBJECTIVE
To analyze outcome and predictive factors for patient survival and patency rates of unresectable malignant biliary obstruction treated with percutaneous transhepatic insertion of metal stents.


METHODS
This is a retroslective analysis of 130 patients treated in one interventional radiological center with data collected from patient records and by telephone interviews. The procedure-related data had been prospectively documented in a computer data base. The Kaplan-Meier analysis was performed for univariate and multivariate comparison of survival and patency rates with the log-rank test used for different tumor types. Predictive factors for survival and 30-day mortality were analyzed by a stepwise logistic regression.


RESULTS
Underlying causes of malignant biliary obstructions were cholangiocarcinoma in 50, pancreatic carcinoma in 29, liver metastases in 27, gallbladder carcinoma in 20, and other tumors in 4 patients. The technical success rate was 99 %, the complication rate 27 % and the 30-day mortality 11 %. Primary patency rates (406 days with a median of 207 days) did not differ significantly for different tumor types. The survival rates were significantly (p = 0.03 by log-rank test) better for patients with cholangiocarcinoma than for patients with pancreatic carcinoma and liver metastases. Multiple regression analysis revealed no predictive factor for patient survival and 30-day mortality.


CONCLUSIONS
Percutaneous transhepatic insertion of metal biliary endoprostheses offers a good initial and long-term relief of jaundice caused by malignant biliary obstruction. Although survival rates for patients with cholangiocarcinoma are better than for other causes of malignant biliary obstruction, a clear predictive factor is lacking for patients undergoing palliative biliary stent insertion.
Alfke
H
H
Klinik für Strahlendiagnostik Philipps Universität Marburg. alfke@mailer.uni-marburg.de
Alfke
B
B
Froelich
J J
JJ
Klose
K J
KJ
Wagner
H-J
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002758:Cholangiography; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis