CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S13
DOI: 10.1055/s-0041-1730680
Abstract

The Outcomes of Percutaneous Transhepatic Cholangiography for the Palliation of Malignant Jaundice in England Between 2001 and 2014

Nigel Trudgill
Department of Sandwell General Hospital, Singapore
,
James Rees
Liver Unit, Queen Elizabeth Hospital, Birmingham, Singapore
,
Felicity Evison
Health Informatics Department, Queen Elizabeth Hospital, Singapore
,
Jemma Mytton
Health Informatics Department, Queen Elizabeth Hospital, Singapore
,
Prashant Patel
School of Cancer Sciences, University of Birmingham, Birmingham, UK, Singapore
,
Kamarjit Singh Mangat
Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
› Author Affiliations

Background: Relieving obstructive jaundice in patients with inoperable pancreatobiliary cancers improves quality of life and permits palliative chemotherapy. Percutaneous transhepatic cholangiography (PTC) with biliary drainage and/or biliary stenting and are commonly used to relieve obstructive jaundice in such patients, and we have examined outcomes of PTC in a national patient cohort. Methods: A retrospective cohort study of all patients undergoing PTC as part of palliative therapy of pancreatobiliary cancer in England between April 2001 and March 2014, identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality. Results: A total of 16,822 individuals undergoing PTC were analyzed (median age 72 [range 19–104], 50.3% males). About 58% had pancreatic and 30.1% had biliary tract cancer. In-hospital and 30-day mortality was 15.3 (95% confidence interval 14.7%–15.9%) and 23.1 (22.4%–23.8%), respectively. About 36% suffered a complication: sepsis (16.5%), stent blockage or displacement (6.4%), and acute kidney injury (4.7%). Thirty-day mortality was associated with increasing age (81+ odds ratio 2.68 [2.37–3.03], P < 0.001), comorbidity (Charlson score 20+, 3.10 [2.64–3.65], P < 0.001), and preexisting renal dysfunction (2.37 [2.12–2.65], P < 0.001), increasing deprivation (1.28 [1.13–1.44], P < 0.001), and cancer type other than pancreatic (unspecified biliary tract 1.28 [1.08–1.52], P = 0.004). Females had a better prognosis (0.91 [0.84–0.98], P = 0.011), as did those undergoing PTC in a “high-volume” provider (84–180 PTCs 0.68 [0.58–0.79], P < 0.001). Conclusion: In subjects undergoing PTC for the palliative relief of malignant jaundice, 30-day mortality is 23.1% and complications occur in 36%. Mortality is higher in older males, those with increasing comorbidity and when the procedure is carried out by operators performing low volumes of PTC.



Publication History

Article published online:
11 May 2021

© 2018. The Arab Journal of Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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