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A preliminary single-center investigation of percutaneous biliary stenting in malignant hilar biliary obstruction: what impacts the clinical success and the long-term outcomes?

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Abstract

Purpose

The purpose of this study is to investigate the influencing factors that may impact the clinical success, jaundice-free time, and overall survival in patients of malignant hilar biliary obstruction (MHBO) treated with a self-expanding metallic stent (SEMS).

Materials and methods

Patients diagnosed with MHBO and treated with SEMS through percutaneous access from 1 Jul. 2013 to 1 Jul. 2018 were enrolled in this monocentric study. Demographic information, disease baseline measurements, and interventional strategies were collected and examined. Bilirubin was measured 1–3 days before and 3–7 days after stenting using the unit of “μmol/L.” The bilirubin reduction ratio was compared between different study groups, which were separated by specific characteristics. Univariate and multivariate analyses were performed to evaluate each characteristic’s impact on jaundice-free time (JF) and overall survival time (OS). Statistical analyses were conducted using SPSS 14.0, p < 0.05 indicated significance.

Results

Eighty patients were enrolled. Direct bilirubin (DB) and indirect bilirubin (IB) both significantly decreased after stenting (U = 1575.0, p < 0.001; U = 1541.0, p < 0.001). The DB reduction ratio of the “nearby lymph metastases” group was significantly higher (U = 566.0, p = 0.037). The IB reduction ratio in the “single stent” group was significantly higher (U = 554.0, p = 0.018). Sixty-six cases reached jaundice recurrence, the median JF was 6 months, and the 95% confidence interval was 4.411 ~ 7.589 months. Fifty-eight cases ended in death, the median OS was 7 months, and the 95% confidence interval was 5.759 ~ 8.241 months. “Nearby lymph metastases” and “distant metastases” independently impacted OS (OR = 2.344, p = 0.013; OR = 3.239, p = 0.042). “IB reduction ratio” independently impacted both JF and OS (OR = 0.422, p = 0.021; OR = 0.315, p = 0.001).

Conclusion

The goal of treatment in patients with MHBO is to recover liver function. However, the overall survival is greatly impacted by the presence of metastases. Managing to obtain adequate liver function recovery may improve the long-term outcomes in affected patients.

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Data availability

The clinical data supporting the results of this paper were obtained from the Electronic Medical Records of Shengjing Hospital, the usage of which had been approved by the hospital’s ethics committee. Public sharing of the data used in this study is not available out of respect for patient privacy.

Code availability

The statistical data in the paper were generated using software SPSS and X tile, both of which are open resource.

Abbreviations

MHBO:

Malignant hilar biliary obstruction

HCCA:

Hilar cholangiocarcinoma

PS:

Plastic stent

SEMS:

Self-expanded metallic stent

PTBD:

Percutaneous transhepatic biliary drainage

PTBS:

Percutaneous transhepatic biliary stenting

DB:

Direct bilirubin

IB:

Indirect bilirubin

JF:

Jaundice-free time

OS:

Overall survival time

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Authors and Affiliations

  1. Department of Radiology, Shengjing Hospital of China Medical University, Huaxiang Road 39, Shenyang City, 110004, Liaoning Province, China

    Xiaonan Mao, Feng Wen, Hongyuan Liang, Wei Sun & Zaiming Lu

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Contributions

Conceptualization: Zaiming Lu, Xiaonan Mao; Data curation: Zaiming Lu, Xiaonan Mao; Formal analysis: Xiaonan Mao; Funding acquisition: Xiaonan Mao; Investigation: Xiaonan Mao, Feng Wen, Hongyuan Liang, Wei Sun; Methodology: Zaiming Lu, Xiaonan Mao; Project administration: Zaiming Lu; Resources: Xiaonan Mao, Feng Wen, Hongyuan Liang, Wei Sun; Supervision: Zaiming Lu; Validation: Xiaonan Mao, Feng Wen, Hongyuan Liang, Wei Sun; Visualization: Xiaonan Mao, Feng Wen, Hongyuan Liang, Wei Sun; Writing—original draft: Xiaonan Mao; Writing—review & editing: Zaiming Lu, Xiaonan Mao.

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Correspondence to Zaiming Lu.

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Ethics approval

Our research was performed in accordance with the principles stated in the Declaration of Helsinki. The present study, which was approved by the Ethics Committee of Shengjing Hospital of China Medical University, was retrospective. We gave no interventions to patients beyond routine clinical management and only clinical data were collected and analyzed. Consent to participate and publish was obtained from all patients and they were aware that all data would be kept anonymized.

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We have informed all participants why the research was conducted, and how the data we collected were stored. Written informed consent was obtained from all patients, or their legal representatives, notifying them that their clinical data may be used and published in future research. All patients’ data will be kept anonymized.

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We have informed all participants why the research was conducted, and how the data we collected were stored. Written informed consent was obtained from all patients, or their legal representatives, notifying them that their clinical data may be used and published in future research. All patients’ data will be kept anonymized.

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Mao, X., Wen, F., Liang, H. et al. A preliminary single-center investigation of percutaneous biliary stenting in malignant hilar biliary obstruction: what impacts the clinical success and the long-term outcomes? . Support Care Cancer 29, 6781–6792 (2021). https://doi.org/10.1007/s00520-021-06271-0

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