PERCUTANEOUS TRANSHEPATIC CHOLANGIO DRAINAGE (PTCD) FOR MALIGNANT BILIARY STENOSES – THE ONCOLOGIC OUTCOME IN A GERMAN TERTIARY CENTER

Aims For more than 50 years, PTCD remains a palliative treatment option for patients with malignant biliary stenoses where ERCP fails. With this retrospective analysis, a closer look on the oncologic outcome of patients after PTCD drainage was taken. A primary endpoint was the ability to receive or return to a point where chemotherapy was possible again.

Methods Between 2014 and 2018, we conducted a retrospective anaylsis of patients with benign or malign bile duct stenoses at the University Medical Center Göttingen. General patient characteristics as well as procedure related data, PTCD success, laboratory results and mainly achieving chemotherapy were collected. A cut off bilirubin of 5 mg/dl was set for safe chemotherapy application.

Results A total of 147 patients received PTCD placement for benign (n = 38) or malign biliary stenoses (n = 102) at the University Medical Center Göttingen (90 m, 57 w). In seven patients, diagnosis was unclear. Causes for malignant stenoses were pancreatic head cancer (n = 34), Cholangiocellular carcinoma (n = 29), ampullar carcinoma (n = 6) and metastases of distant tumor entities (n = 23). Main reasons for benign stenoses were bile duct stones (n = 12) and stenosing biliodigestive anastomosis (n = 6). At the end of our analysis, 27 patients were alive. After PTCD placement, 58 patients with malignant stenoses experienced sufficient serum bilirubin regression and initiation or a return to chemotherapy was possible (56%). 42 patients with malignant stenoses received best supportive care (41%). 30d mortality after PTCD was 9.5% (n = 14/147 patients). Mean overall survival after PTCD for both entities was 123.19d. 5 patients died due to causes directly releated to PTCD (3.4%).

Conclusions This retrospective analysis shows that chemotherapy after PTCD for malignant biliary stenosis was possible in 56%. Main reasons for PTCD placement are patients with non accessible bile ducts via ERCP due to pancreatic head cancer or cholangiocellular carcinoma. Prospective data are missing so far.