José António Ferraz Gonçalves1, Eugénia Rosendo2, Luciana Sousa3, Ana Rita Lopes4, Inês Leão5, Rita Queirós6, Sara Marote7, Maria José Sousa4. 1. Palliative Care Service, Instituto Português de Oncologia, R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal. ferrazg@ipoporto.min-saude.pt. 2. Centro Hospitalar e Universitário do Porto, Porto, Portugal. 3. Hospital de Braga, Braga, Portugal. 4. Palliative Care Service, Instituto Português de Oncologia, R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal. 5. Centro Hospitalar de Vila Nova de Gaia / Espinho, Espinho, Portugal. 6. Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal. 7. Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal.
Abstract
PURPOSE: Biliary tract obstruction in cancer patients is usually associated with a poor prognosis. The obstruction may cause distressing symptoms, such as pruritus. As this situation occurs mostly in advanced cancer, the primary objective of the treatment is in many cases symptom control and not prolonging life. However, some patients can be candidates for chemotherapy. To see the outcomes of stenting insertion in patients of our oncology center. METHODS: A retrospective study of patients who have undergone this procedure between 1 October 2011 and 31 December 2018 was carried out. RESULTS: Insertion of a biliary stent was performed in 171 patients. The most common diagnoses were gastric and colorectal cancers, each with 42 (24%), followed by pancreatic (34 (20%)) and biliary tract cancer (25 (14%)). Most stents (155 (91%)) were placed percutaneously. Complications were seen in 91 (53%) patients and the most common was cholangitis in 48 (53%) patients, and the median survival was 75.5 days (3-1246). A total of 168 (98%) patients were referred to palliative care. In a multivariable analysis, the ECOG performance status was associated with survival, with the ECOG 0, 1, and 2 associated with better survival and peritoneal metastases associated with lower survival. CONCLUSIONS: For many patients with advanced cancers, it may not be clear if the benefits of palliative biliary stents outweigh the risks. Therefore, the problem should be discussed with the patients and their families, making clear the goals of care and the potential benefits and risks that can be expected.
PURPOSE: Biliary tract obstruction in cancer patients is usually associated with a poor prognosis. The obstruction may cause distressing symptoms, such as pruritus. As this situation occurs mostly in advanced cancer, the primary objective of the treatment is in many cases symptom control and not prolonging life. However, some patients can be candidates for chemotherapy. To see the outcomes of stenting insertion in patients of our oncology center. METHODS: A retrospective study of patients who have undergone this procedure between 1 October 2011 and 31 December 2018 was carried out. RESULTS: Insertion of a biliary stent was performed in 171 patients. The most common diagnoses were gastric and colorectal cancers, each with 42 (24%), followed by pancreatic (34 (20%)) and biliary tract cancer (25 (14%)). Most stents (155 (91%)) were placed percutaneously. Complications were seen in 91 (53%) patients and the most common was cholangitis in 48 (53%) patients, and the median survival was 75.5 days (3-1246). A total of 168 (98%) patients were referred to palliative care. In a multivariable analysis, the ECOG performance status was associated with survival, with the ECOG 0, 1, and 2 associated with better survival and peritoneal metastases associated with lower survival. CONCLUSIONS: For many patients with advanced cancers, it may not be clear if the benefits of palliative biliary stents outweigh the risks. Therefore, the problem should be discussed with the patients and their families, making clear the goals of care and the potential benefits and risks that can be expected.
Authors: Gabriel Mayo Vieira de Souza; Igor Braga Ribeiro; Mateus Pereira Funari; Diogo Turiani Hourneaux de Moura; Maria Vitória Cury Vieira Scatimburgo; João Remí de Freitas Júnior; Sergio A Sánchez-Luna; Renato Baracat; Eduardo Turiani Hourneaux de Moura; Wanderley Marques Bernardo; Eduardo Guimarães Hourneaux de Moura Journal: World J Hepatol Date: 2021-05-27