Effective palliation of malignant biliary duct obstruction

The efficacy of palliative biliary decompression by operative and percutaneous methods was evaluated in 106 patients with unresectable malignancies obstructing the biliary system. Seventy patients had operative and 36 had percutaneous decompression. Primary malignancies of the pancreas and bile ducts were most common. Percutaneous transhepatic decompression was achieved beyond the site of obstruction in 72% of patients. Overall hospital mortality was 25% for patients having percutaneous catheter decompression and 17% for those patients operated upon. Early postoperative death was significantly related to: (1) age greater than 70 years; (2) preadmission weight loss greater than 15 pounds; (3) prothrombin time prolonged more than 2.5 seconds; and (4) hepatic metastases. Major complications were encountered in 56% of survivors of percutaneous drainage and 36% of those surviving operation. Intubation of the bile ducts due to inability to bypass the obstruction at operation was associated with the highest mortality (50%) and morbidity (86%). Mean survival was 14 months after operation, compared to 5 months after percutaneous decompression. The authors concluded that percutaneous decompression of the biliary tree is useful palliative treatment for those patients with proximal biliary obstruction due to malignancy when estimated operative risk is high, but operative decompression offers most patients the opportunity for longer survival with lower ultimate mortality and morbidity.