Introduction Percutaneous transcutaneous cholangiography (PTC) is widely used to relieve malignant obstructive jaundice, especially when endoscopic retrograde cholangiopancreatography (ERCP) has failed. Decompression of the biliary tree in patients who are not suitable for surgical resection may improve quality of life and facilitate palliative chemotherapy.
Methods Using Hospital Episode Statistics (HES), patients with cancer of the pancreas, biliary tree, gallbladder, small intestine and liver that underwent PTC were identified. Patients who underwent curative resection post PTC were excluded. Mortality, complication rates, readmissions and variation in outcomes between healthcare providers were examined. Associations between age, sex, comorbidity, cancer type and mortality were examined using multivariate regression analysis.
Results Between April 2001 and March 2014, 16,363 subjects were identified (50.2% male and mean age 73). Pancreatic cancer was the most common site at 58% and 61.1% of patients had undergone a previous ERCP. In-hospital and 30 day mortality was 15.3% (CI14.8–15.9%) and 23.1% (CI 22.5–23.8%) respectively and median survival was 92 days (IQR 33–244). There was no reduction in mortality over the study period. The percentage of patients receiving chemotherapy after their PTC was 40.7% in those aged under 60 but fell to 2.5% in those aged over 80. Emergency readmission rate was 20.6%. 35.7% of patients suffered a serious complication after their procedure, the most common being infective (16.2%), stent blockage or displacement (6.2%) and acute kidney injury (4.7%). 30 day mortality was associated with increasing age (80+ years, OR 2.91 (95% CI 2.53–3.33) p < 0.001), a higher comorbidity score (20+ 3.03 (2.57–3.56) p < 0.001) and pre-existing renal dysfunction (2.23 (2.00–2.40) p < 0.001). Female patients had a better outlook at 30 days (0.90 (0.84–0.97) p = 0.009). 30 day mortality varied from 9.1 to 50% across providers and it was lowest in hospitals performing a higher volume of procedures per year (50+ 0.80 (0.71–0.91) p < 0.001).
Conclusion In subjects undergoing PTC for the palliative relief of malignant jaundice, 30 day mortality is 23.1%, major complications occur in 35.7% and readmission occurs in 20.6%. Mortality is highest in older males with increasing co-morbidity and in trusts performing low volumes of procedures. Careful multidisciplinary selection of patients who will benefit from PTC for relief of significant symptoms from jaundice or as a bridge to chemotherapy is clearly merited.
Disclosure of Interest None Declared
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