Obstructive icterus in patients with hepatic tumor. Result of non-surgical biliary drainage

Seventeen patients with biliary obstruction and hepatic tumors were treated by endoscopic or percutaneous transhepatic drainage with an endoprothesis. There were 9 men and 8 women (mean age = 61 +/- 13 years). Four patients had primary hepatic carcinoma and 13 had hepatic metastases. Decrease of serum bilirubin of more than 75 percent was achieved in 12 of the patients (71 percent). The success rate was related to the level of the biliary obstacle and not to the importance of hepatic parenchymal involvement. Failure was significantly more frequent (p = 0.003) in patients with type III hilar strictures compared to the other patients with pedicular or type I and II hilar strictures. Cholangitis was the major complication (29 percent) and occurred only in the patients with type III hilar strictures. Mortality was 24 percent at 30 days. This rate was 57 percent in the group of patients with type III hilar strictures and significantly higher (p = 0.015) than other patients. Cumulative survival was better in patients with relief of jaundice than that observed in the other patients (p less than 0.01). Two patients with metastatic carcinoma of the breast treated by chemotherapy survived more than 20 months without jaundice. Analysis of these data indicates that in patients with hepatic tumors and obstructive jaundice, palliative treatment with endoprothesis can provide relief of jaundice and that prolonged survival may be observed in patients with chemosensible tumors.