Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy Journal Article
| Authors: | Thornton, R. H.; Ulrich, R.; Hsu, M.; Moskowitz, C.; Reidy-Lagunes, D.; Covey, A. M.; Brody, L. A.; Robson, P. M.; Sofocleous, C. T.; Solomon, S. B.; Getrajdman, G. I.; Brown, K. T. |
| Article Title: | Outcomes of patients undergoing percutaneous biliary drainage to reduce bilirubin for administration of chemotherapy |
| Abstract: | Purpose: To describe outcomes in patients undergoing percutaneous biliary drainage to reduce total serum bilirubin level for administration of chemotherapy. Materials and 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. © 2012 SIR. |
| Keywords: | adult; cancer chemotherapy; child; school child; aged; major clinical study; overall survival; patient selection; pancreas cancer; outcome assessment; follow up; treatment indication; demography; metastasis; bleeding; bilirubin; liver; medical information; bile leakage; medical record; imaging; bile duct carcinoma; biliary tract drainage; gallbladder cancer; bilirubin blood level; infusion pump; international normalized ratio |
| Journal Title: | Journal of Vascular and Interventional Radiology |
| Volume: | 23 |
| Issue: | 1 |
| ISSN: | 1051-0443 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2012-01-01 |
| Start Page: | 89 |
| End Page: | 95 |
| Language: | English |
| DOI: | 10.1016/j.jvir.2011.09.022 |
| PROVIDER: | scopus |
| PUBMED: | 22115568 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 March 2012" - "CODEN: JVIRE" - "Source: Scopus" |
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