[Long-term retrospective analysis of metallic stents in malignant biliary obstruction]

To analyze and evaluate of the long-term follow-up data of 152 patients with inoperable malignant biliary obstruction who underwent percutaneous placement of metallic stents.

From 2000 through 2006, 152 consecutive patients with malignant biliary obstruction were treated with PTCD or placement of metallic stents. The causes of obstruction were bile duct carcinoma (n=35)ìpancreatic carcinoma (n=32), hepatocellular carcinoma and metastatic (n=61), lymphadenopathy in the hepatoduodenal ligament (n=24). We used 86 stents: 31 Cook Zilver Stentsì25 Sinus Superflex Stentsì12 Wall Stentsì3 Sinus-s Iliaca Stentsì3 ZA-S Bliary Design Stentsì5 Smart Stents and 7 other stents. Every three months we followed up all patients except those who died. Patient survival and stent patency rates were estimated by life-table analysis. The Kaplan-Meier method (log-rank test) was used to compare the patency and survival rates among different groups. And the COX regression model was established to compare the relative risks.

The overall median length of patency of all stents was 314 days. The median length of survival for the entire patient group was 215 days. The survival rate was 79.1%ì51.7% and 26.8% after 3, 6, and 9 months, respectively. Six patients developed recurrent jaundice or cholangitis. The patients with hepatic hilar obstruction group indicated worse prognosis (P< or =0.05).

Metallic stents showed a favorable patency rate with regard to patient survival. In patients with hilar obstruction, the clinical prognosis was worse than that in patients with common bile duct (CBD) obstruction. We believe that the placement of metallic stents is the procedure of choice for palliation of malignant biliary obstruction.