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Clinical results after biliary drainage by endoscopic retrograde cholangiopancreatography for analysis of metastatic cancer survival and prognostic factors

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Abstract

Background

Malignant biliary obstruction secondary to metastatic cancer is associated with poor prognosis. To the best of our knowledge, no previous study has investigated long-term survival and associated prognostic factors after biliary endoscopic retrograde cholangiopancreatography (ERCP) drainage for obstruction jaundice secondary to various types of metastatic cancer.

Methods

This retrospective study included 60 patients who underwent biliary ERCP drainage for obstructive jaundice secondary to metastatic cancer at two hospitals during the period from November 2012 to December 2019. Multivariate analysis was conducted to identify independent prognostic factors.

Results

Biliary drainage was successfully achieved in 55 (91.7%) patients, 37 of whom received subsequent treatment. Overall median survival time was 133 days after stent placement. The overall survival (OS) rates after ERCP drainage were significantly better in the post-drainage treatment group than in the post-drainage untreated group (239 days vs. 45 days, p < 0.001). Good ECOG performance status before drainage, albumin level ≥ 35 g/L, successful drainage, absence of ascites, and post-drainage treatment were identified as factors of improved survival in univariate analysis. ECOG performance status and post-drainage treatment were independent predictors of OS in multivariate analysis.

Conclusions

We showed that stent placement with ERCP was a safe and effective treatment method for patients with malignant biliary obstruction caused by metastatic cancer and may be preferred over percutaneous transhepatic biliary drainage. Post-drainage treatment and a good ECOG performance status were predictors of better prognosis.

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Acknowledgements

We appreciate the hard work of the colleagues at the database center of two hospitals who helped us reserve and search the relative data. Furthermore, we thank the Enago editing service.

Funding

This study was funded by Beijing Municipal Administration of Hospitals Incubating Program (Grant Number PX 2,020,047).

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Author notes

  1. Peng Yuan, Lei Zhang, and Shijie Li are authors contributed equally to this work.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital and Institute, #52, Fucheng Road, Haidian, Beijing, People’s Republic of China

    Peng Yuan, Shijie Li & Qi Wu

  2. Department of Hepatobiliary Surgery, The First Hospital of Lanzhou University, Lanzhou, People’s Republic of China

    Lei Zhang & Xun Li

Authors
  1. Peng Yuan
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  2. Lei Zhang
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  3. Shijie Li
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  4. Xun Li
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  5. Qi Wu
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Contributions

As the leading principle investigator of the study, Professor WQ, LX contributed significantly to the study design and final approval of the article. YP contributed to data analysis and drafting of the manuscript. ZL, LSJ were responsible for analysis and interpretation of the data and critical revision of the article for important intellectual content. All authors provided significant input to the paper by means of revisions and all have read and approved the final manuscript.

Corresponding authors

Correspondence to Xun Li or Qi Wu.

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Disclosures

Drs. Peng Yuan, Lei Zhang, Shijie Li, Xun Li, Qi Wu have no conflicts of interest or financial ties to disclose.

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Yuan, P., Zhang, L., Li, S. et al. Clinical results after biliary drainage by endoscopic retrograde cholangiopancreatography for analysis of metastatic cancer survival and prognostic factors. Surg Endosc 35, 6220–6226 (2021). https://doi.org/10.1007/s00464-020-08121-2

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  • DOI: https://doi.org/10.1007/s00464-020-08121-2

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