Abstract
Introduction
Malignant biliary obstruction (MBO) is a common complication of advanced hepatopancreaticobiliary cancers, often presenting with jaundice, functional decline, and high symptom burden that significantly impairs quality of life. Percutaneous transhepatic biliary drainage (PTBD) is frequently used to relieve MBO when endoscopic drainage is not feasible, including patients receiving palliative care. However, evidence on clinical outcomes in palliative care populations remains limited.
Aim
To evaluate short-term clinical outcomes of PTBD in patients with advanced MBO receiving palliative care, focusing on 90-day mortality, clinical success, symptom control, functional status, procedure-related complications, reintervention, and access to chemotherapy.
Methods
This single-cohort, descriptive observational study included patients with MBO who underwent PTBD between 2022 and 2024. Patients were followed for 90 days after the procedure. Functional status was assessed using the Karnofsky Performance Status (KPS), and symptom burden was evaluated using the Edmonton Symptom Assessment System (ESAS).
Results
Seventy-four patients were included (mean age: 65.5 years; 55.4% male). The most frequent malignancies were pancreatic cancer and cholangiocarcinoma. 90 days mortality after the procedure was 74.3%. Clinical success was achieved in 55.4% of cases. Symptomatic relief was observed for pruritus (95%) and pain (89%), although functional decline was noted. Procedure-related complications occurred in 23.0% of patients, and 43.2% required reintervention.
Conclusions
PTBD provided symptomatic relief; however, functional status declined and short-term mortality was high, consistent with the advanced disease stage of this cohort. These findings underscore the importance of individualized, comfort-focused decision-making aimed at optimizing symptom control and quality of life in palliative care patients.