Clinical outcome of malignant biliary obstruction caused by metastatic gastric cancer

Abstract

Background: The clinical outcome of malignant biliary obstruction caused by metastatic gastric cancer remains unclear. This study was designed to evaluate the clinical outcome and predictive factors of survival in patients who underwent percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction caused by metastatic gastric cancer.

Methods: Between April 1997 and March 2006, 38 consecutive patients with malignant biliary obstruction caused by metastatic gastric cancer were retrospectively analyzed. All patients underwent PTBD.

Results: After PTBD, serum bilirubin levels significantly decreased in 29 (76%) of 38 patients. Pruritus, fever, jaundice, anorexia, abdominal pain, and general fatigue improved significantly in 100%, 100%, 78%, 64%, 53%, and 48% of patients, respectively. Early complications related to the intervention occurred in ten patients. Seven patients developed symptoms of recurrent jaundice or cholangitis. Overall median survival was 79 days, and 6-month and 1-year survival rates after PTBD were 39.5% and 13.2%, respectively. Serum bilirubin level after PTBD (P < 0.0001), chemotherapy after PTBD (P < 0.0001), and performance status at presentation (P = 0.0363) were found to be independent predictors of survival.

Conclusion: PTBD with metallic stent placement is a safe and effective palliation for patients with malignant biliary obstruction caused by metastatic gastric cancer. Our results suggest that patients in good clinical condition are candidates for aggressive treatment with a combination of PTBD with metallic stent placement and chemotherapy.