悪性肝外胆道閉塞に対する経皮的金属ステント留置術：612例における単一施設経験

BackgroundMalignant extrahepatic biliary obstruction is most commonly caused by pancreatic cancer or cholangiocarcinoma and is frequently diagnosed at an advanced stage. Palliation with percutaneous metallic stent placement is often required, but data on large-scale outcomes remain limited.PurposeTo investigate the technical and clinical outcomes of percutaneous metallic stent placement in patients with malignant extrahepatic biliary obstruction and to examine the factors that influence patient survival and stent patency duration.Material and MethodsBetween January 2007 and December 2020, 612 patients (370 men, 242 women, mean age = 63.6 years; age range = 25-90 years) with malignant extrahepatic biliary obstruction were included in this retrospective study.ResultsPercutaneous metallic stents were successfully placed in all 612 patients. A total of 76 (12%) patients had major (n = 50, 8%) or minor (n = 26, 4%) complications. The percutaneous drainage catheter was successfully removed in 553 (90%) patients. In total, 53 patients were lost to follow-up and seven patients underwent subsequent biliary operation after stent placement. Stent occlusion occurred in 158/493 (32%) patients and median stent patency time was 274 days. Multivariate Cox regression analyses revealed that primary malignancy (P <0.001), stent patency (P <0.001), chemotherapy (P <0.001), and isolated biliary obstruction (P = 0.001) were independently associated with longer survival.ConclusionPercutaneous metallic stent placement is safe and effective in patients with malignant extrahepatic biliary obstruction. In addition, primary malignancy, stent patency, chemotherapy, and isolated biliary obstruction are significantly associated with longer survival within this poor-prognosis cohort.