The effect of selective therapy on malignant obstructive jaundice.

To determine the impact and use of alternative treatment methods of draining malignant obstructive jaundice, a review of 41 patients who were managed by a surgical hepatobiliary service, in which non-surgical (endoscopic and radiological) treatment modalities were available equally, was performed. Of the 41 patients, 39 patients experienced 45 attempted treatments with ultimate success in 35 (90%) patients. The non-operative management of the high-risk patients did not result in a higher mortality at 9% and 25% for endoscopic and radiological management, respectively, than that of 15% which was achieved in the operative series. As a result of treatment selection, the non-operative groups survived for a shorter time (eight weeks) than did those who underwent operation (survival, 30 weeks). This shorter survival time resulted in a similar readmission rate for the non-operative and operative groups; patients did not survive long enough in the non-operative group to develop stent complications. Even if surgery is the chosen treatment modality, preoperative endoscopic retrograde cholangiopancreatography is recommended in planning that surgery. We conclude that in patients with malignant obstructive jaundice, surgical treatment has the advantage of fewer late complications, while non-surgical treatment has the advantage of less initial morbidity or mortality. If the aim is to optimize palliation not only in the short term, but also in the longer term, then the selection of patients for treatment on the basis of pretreatment imaging results, the operative risk and the predicted duration of survival, will result in operative and non-operative methods of treatment being used approximately equally.