Background: Percutaneous metal stenting is an accepted palliative
treatment for malignant biliary obstruction. Nevertheless, factors
predicting survival are not known.
Methods: Seventy-six patients with inoperable malignant biliary
obstruction were treated with percutaneous placement of metallic stents.
Twenty patients had non-hilar lesions. Fifty-six patients had hilar
lesions classified as Bismuth type I (n = 15 patients), type II (n =
26), type III (n = 12), or type IV (n = 3 patients). Technical and
clinical success rates, complications, and long-term outcome were
recorded. Clinical success rates, patency, and survival rates were
compared in patients treated with complete (n = 41) versus partial (n =
35) liver parenchyma drainage. Survival was calculated and analyzed for
potential predictors such as the tumor type, the extent of the disease,
the level of obstruction, and the post-intervention bilirubin levels.
Results: Stenting was technically successful in all patients (unilateral
drainage in 70 patients, bilateral drainage in 6 patients) with an
overall significant reduction of the post-intervention bilirubin levels
(p < 0.001), resulting in a clinical success rate of 97.3%. Clinical
success rates were similar in patients treated with whole-liver drainage
versus partial liver drainage. Minor and major complications occurred in
8% and 15% of patients, respectively. Mean overall primary stent
patency was 120 days, while the restenosis rate was 12%. Mean overall
secondary stent patency was 242.2 days. Patency rates were similar in
patients with complete versus partial liver drainage. Mean overall
survival was 142.3 days. Survival was similar in the complete and
partial drainage groups. The post-intervention serum bilirubin level was
an independent predictor of survival (p < 0.001). A cut-off point in
post-stenting bilirubin levels of 4 mg/dl dichotomized patients with
good versus poor prognosis. Patient age and Bismuth IV lesions were also
independent predictors of survival.
Conclusions: Percutaneous metallic biliary stenting provides good
palliation of malignant jaundice. Partial liver drainage achieved
results as good as those after complete liver drainage. A serum
bilirubin level of less than 4 mg/dl after stenting is the most
important independent predictor of survival, while increasing age and
Bismuth IV lesions represent dismal prognostic factors