Outcomes of antegrade biliary decompression for obstructive jaundice caused by colorectal cancer metastases

Aim. To evaluate antegrade biliary decompression as part of the multimodal treatment of patients with obstructive jaundice caused by colorectal cancer metastases.

Materials and Methods. The study included 85 patients (mean age 60.7 ± 11.7 years) with obstructive jaundice caused by metastatic colorectal cancer. The mean serum bilirubin level at admission was 297.99 ± 158.99 (35.1–785.2) µmol/L, and the duration of jaundice was 17.54 ± 13.43 (3–90) days, which precluded initiation or continuation of systemic therapy. Prior to the onset of jaundice, patients had received 1.36 ± 1.36 (0–5) lines of chemotherapy and 11.52 ± 12.10 (0–63) treatment cycles. All patients underwent antegrade biliary drainage: external (n = 7), external–internal suprapapillary (n = 60), or modified external drainage (n = 18).

Results. Clinical success of antegrade biliary decompression (reduction of bilirubin <40 µmol/L) was achieved in 48 patients (56%). Subsequent chemotherapy was administered to 29 patients (34.15%); 19 patients did not receive chemotherapy due to severe clinical condition. Complications occurred in 14.1% of cases, most commonly drain dislodgement. One-year survival among patients who received systemic anticancer therapy after decompression was 34% (n = 10), and 8.9% (n = 5) among those who did not. Age >66 years, bilirubin >400 µmol/L, and impaired hepatic protein synthesis function were statistically significant independent negative predictors of receiving systemic therapy after decompression. The associated risk ratios ranged from 41.7% to 100%.

Conclusion. Antegrade biliary drainage in its various modifications is an effective method of biliary decompression that enables initiation or continuation of systemic therapy in patients with colorectal cancer metastases. Decisions regarding the indication and type of drainage should be made by a multidisciplinary team using a multifactorial assessment of the condition and prognosis of patients.

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