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Multicenter Study
. 2020 Jan 23;10(1):e033576.
doi: 10.1136/bmjopen-2019-033576.

The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study

James Rees  1 , Jemma Mytton  2 , Felicity Evison  2 , Kamarjit Singh Mangat  3   4 , Prashant Patel  5 , Nigel Trudgill  6
Affiliations
Multicenter Study

The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study

James Rees et al. BMJ Open. .

Abstract

Introduction: Relieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.

Methods: Retrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.

Results: 16 822 patients analysed (median age 72 (range 19-104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%-23.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (≥81 years OR 2.68 (95% CI 2.37 to 3.03), p<0.001), increasing comorbidity (Charlson score 20+, 3.10 (2.64-3.65), p<0.001), pre-existing renal dysfunction (2.37 (2.12-2.65), p<0.001) and non-pancreatic cancer (unspecified biliary tract 1.28 (1.08-1.52), p=0.004). Women had lower mortality (0.91 (0.84-0.98), p=0.011), as did patients undergoing PTBD in a 'higher volume' provider (84-180 PTBDs per year 0.68 (0.58-0.79), p<0.001).

Conclusions: In patients undergoing PTBD for the palliation of malignant biliary obstruction, 30-day mortality was high at 23.1%. Mortality was higher in older patients, men, those with increasing comorbidity, a cancer site other than pancreas and at 'lower-volume' PTBD providers.

Keywords: adult palliative care; hepatobiliary tumours; interventional radiology.

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Conflict of interest statement

Competing interests: KSM is the inventor of a biliary biopsy forceps kit that was first licensed in 2013. The rights have been transferred to Cook Medical and he receives minimal royalties for sales of this device.

Figures

Figure 1
Figure 1
Study flow chart. PTBD, percutaneous transhepatic biliary drainage.
Figure 2
Figure 2
Kaplan Meier unadjusted analysis of 30-day mortality following percutaneous transhepatic biliary drainage for unresectable malignant disease by provider volume.
See this image and copyright information in PMC

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