4657 Clinical impact of an optimal biliary drainage in patients with obstructive liver metastases.

Aim of the study : Patients presenting with progressive liver metastases (LM) and obstructive jaundice have a very short survival and cannot be treated by chemotherapy without adequate biliary drainage. The present study aims to review the success rate of stents insertion for biliary obstruction secondary to LM and their impact on clinical symptoms, survival and the administration of additional chemotherapy. Methods : Thirty patients (12 W/18 M) (mean age 61.3; range 35-77) were studied and underwent stents insertion (plastic and/or metal) endoscopically (80%) or percutaneously + endoscopically ( 20%) in order to get a complete biliary drainage. LM originated from colon (n=13), gastric (n=5), breast (n=4), pancreas (n=3) and miscellaneous cancers (n=5). Mean interval between the diagnosis of LM and stent insertion was 9.8 months (0-48). Bile duct strictures were extrahepatic in 6 patients and intrahepatic in 24 patients with 80% of Bismuth III/IV hilar strictures. Results : The overal success rate of complete biliary drainage was 53% after one procedure and 87.5% after a mean number of 3 procedures (1-7) per patient. The mean number of stents per patient was 2.4 : initial stenting=plastic vs metallic stents: 60/40%; reintervention=plastic vs metallic: 44/56%. Prurit, jaundice, abdominal pain, nausea, anorexia and fatigue were significantly improved in 86, 80, 67, 48 and 24% of the cases, respectively. No death was related to the procedures. Serum bilirubin and ALP decreased from 10.6 to 4.3 mg/dl and from 1270 UI to 665 ,respectively. The overall median survival was 4 months (range 1-21) for the whole group and was 9.5 and 1.8 months in the groups of patients having complete vs uncomplete drainage, respectively. Fifty percent of the patients could benefit from an additional chemotherapy; the median survival in the group receiving chemotherapy vs no chemotherapy was 17 vs 2 months (p