DOI: http://dx.doi.org/10.18203/2349-3933.ijam20190121

Survival analysis pattern of patients treated with biliary metallic stent versus patients treated with surgical procedures for hepato-biliary malignancies in a rural tertiary care centre in South India

Shafique A., Poppy Rejoice, Jaipaul Y., Ramasubramanian R., Heber Anandan

Abstract


Background: Tumors of the biliary tract show spectrum ranging from benign to malignant lesions.  Only 20% of tumors are resectable at the time of presentation.  The operative mortality was approximately 5 to 20%. The morbidity rate associated with the surgery is approximately 65%. Options for palliative therapy of biliary tree obstruction include the surgical bypass, percutaneous external drainage/stenting and endoscopic stenting. The aim was to compare the survival pattern of patients treated with biliary Self Expandable Metallic Stents (SEMS) as a palliative procedure to that of patients treated by curative surgery.

Methods: This was a retrospective study. 6-months survival pattern were analysed in 20 patients treated by SEMS and compared with that of 10 patients treated with plastic biliary stents followed by curative surgery.

Results: Survival pattern analysis was done for all 20 patients with SEMS. 7 patients were in >1-year survival, 5 were in >6months survival, 6 expired within 6months, 2 patients were lost to follow up. Survival pattern was compared with 10 patients who had plastic stents followed by curative surgery. Only 1 patient had survival rate >1year post-surgery, 5 patients expired post-surgery in <6months, 2 patients expired few weeks after plastic stent deployment, 2 patients were lost to follow up.

Conclusions: In patients with biliary malignancies with obstruction, biliary SEMS followed up by palliative chemotherapy had better survival rate than patients who had plastic stents followed up with curative surgical procedures.

Keywords


Biliary tract malignancy, Biliary self-expandable metal stent, Palliative treatment

Full Text:

PDF

References


Freeman ML, Sielaff TD. A modern approach to malignant hilar biliary obstruction. Rev Gastroenterol Dis. 2003;3(4):187-201.

Van Laethem JL, De Broux S, Eisendrath P, Cremer M, Le Moine O, Devière J. Clinical impact of biliary drainage and jaundice resolution in patients with obstructive metastases at the hilum. Am J Gastroenterol. 2003;98(6):1271.

Ballinger AB, McHugh M, Catnach SM, Alstead EM, Clark ML. Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut. 1994;35(4):467-70.

Abraham NS, Barkun JS, Barkun AN. Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointestinal Endoscopy. 2002;56(6):835-41.

Van Berkel AM, Van Marle J, Groen AK, Bruno MJ. Mechanisms of biliary stent clogging: confocal laser scanning and scanning electron microscopy. Endoscopy. 2005;37(08):729-34.

Baron TH. Palliation of malignant obstructive jaundice. Gastroenterol Clin North Am. 2006;35(1):101-12.

Taylor MC, McLeod RS, Langer B. Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: a meta‐analysis. Liver Transplantation. 2000;6(3):302-8.

Cvetkovski B, Gerdes H, Kurtz RC. Outpatient therapeutic ERCP with endobiliary stent placement for malignant common bile duct obstruction. Gastrointestinal Endoscopy. 1999;50(1):63-6.

Bueno JT, Gerdes H, Kurtz RC. Endoscopic management of occluded biliary wallstents: a cancer center experience. Gastrointestinal Endoscopy. 2003;58(6):879-84.

Isayama H, Komatsu Y, Tsujino T, Sasahira N, Hirano K, Toda N, et al. A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut. 2004;53(5):729-34.

Cvetkovski B, Gerdes H, Kurtz RC. Outpatient therapeutic ERCP with endobiliary stent placement for malignant common bile duct obstruction. Gastrointestinal Endoscopy. 1999;50(1):63-6.

Levy MJ, Baron TH, Gostout CJ, Petersen BT, Farnell MB. Palliation of malignant extrahepatic biliary obstruction with plastic versus expandable metal stents: an evidence-based approach. Clin Gastroenterol Hepatol. 2004;2(4):273-85.