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.
