title: Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy.
abstract: OBJECTIVE
  To describe outcomes in patients undergoing percutaneous biliary drainage to reduce total serum bilirubin level for administration of chemotherapy.
  
  
  METHODS
  A total of 647 consecutive patients underwent percutaneous biliary drainage between September 2001 and December 2008. In 168, the indication for biliary drainage was to decrease total serum bilirubin level to permit administration of chemotherapy. Of these, 20 were excluded because they had hepatic arterial infusion pumps, leaving 148 patients as the study group. The primary diagnoses for these patients were gallbladder cancer (n = 23), cholangiocarcinoma (n = 21), pancreatic cancer (n = 36), and other metastatic cancers (n = 68). Medical records and imaging studies were reviewed for demographic data, procedural information, pre- and postdrainage total serum bilirubin level levels, 30-day complications, and subsequent biliary procedures.
  
  
  RESULTS
  The probability of attaining a total serum bilirubin level of 1 mg/dL or lower by 100 days was 31% (95% CI, 23%-39%). Predrainage total serum bilirubin level of 9 mg/dL or lower (hazard ratio [HR], 3.27; 95% CI, 1.86-5.75; P < .001), 100% liver drainage (HR 2.73, 95% CI, 1.56-4.78; P <.001), and lower predrainage International Normalized Ratio (INR; HR, 0.80; 95% CI, 0.70-0.92; P = .002) were associated with an increased likelihood of attaining a total serum bilirubin level of 1 mg/dL or lower. The most common indication for follow-up was pericatheter leakage, which occurred in nearly one third of cases. During follow-up, patients required three visits per 100 catheter-days, or approximately one per month. Median overall survival in this population was approximately 3.5 months.
  
  
  CONCLUSIONS
  Only 31% of patients attained a normal serum bilirubin level by 100 days, and median overall survival was 107 days. Careful patient selection is warranted before biliary drainage for this indication. Maximal biliary drainage, a preprocedure total serum bilirubin of less than 9 mg/dL, and a lower INR were factors associated with serum bilirubin normalization in this cohort.
authors: Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H118, New York, NY 10065, USA. thorntor@mskcc.org
authors: Raymond H
authors: RH
authors: Thornton
authors: Robert
authors: R
authors: Ulrich
authors: Meier
authors: M
authors: Hsu
authors: Chaya
authors: C
authors: Moskowitz
authors: Diane
authors: D
authors: Reidy-Lagunes
authors: Anne M
authors: AM
authors: Covey
authors: Lynn A
authors: LA
authors: Brody
authors: Piera M
authors: PM
authors: Robson
authors: Constantinos T
authors: CT
authors: Sofocleous
authors: Stephen B
authors: SB
authors: Solomon
authors: George I
authors: GI
authors: Getrajdman
authors: Karen T
authors: KT
authors: Brown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood*; D002648:Child; D018281:Cholangiocarcinoma / Q000188:drug therapy*; D004322:Drainage / Q000379:methods*; D005260:Female; D005706:Gallbladder Neoplasms / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000188:drug therapy*; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin