Abstract :
Background: Most cholangiocarcinoma patients present at an advanced stage of the disease. Palliative treatment options include PTBD and ERCP with biliary stenting. Although quality of life (QOL) is of importantce in terminal or advanced malignancy, a number of studies on palliative ERCP and biliary stenting focus mostly on stent patency and survival, with limited data on QOL outcomes. The present study was aimed to assess QOL in patients with unresectable complex hilar cholangiocarcinoma who had undergone endoscopic biliary drainage.
Patients and Methods: Twenty-seven patients with unresectable Bismuth type II-IV hilar cholangiocarcinoma were prospectively treated with either plastic or metallic stent. QOL was assessed at baseline(prior to treatment) and 2-4 weeks after endoscopic biliary stent insertion, using the format of the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep). QOL scores for the pre-treatment and the post-treatment groups were analyzed.
Results: Biliary drainage was associated with post-treatment reduction of serum bilirubin by 14.68 mg/dL (p >0.05). Patients reported improved social and domestic, emotional, functional, and hepatobiliary cancer subscale scores, but decreased physical well-being scores. Total FACT-Hep scores improved 5.62 points after treatment. No statistical significance was detected. Patients with successful drainage (n = 22) showed more QOL improvement, especially regarding emotional well-being in which statistical significance was detected (p <0.05). The majority (46%) exhibited clinically significant improvement of FACT-Hep scores.
Conclusion: Palliative unilateral biliary drainage can decrease symptoms of jaundice and improved QOL of the patients. Statistical improvement of emotional well-being was shown in patients with successful drainage. Further study with larger sample size is needed.
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file/Thai-Journal-of-gastroenterology-vol-12-no-1-3674465.pdf