OBSTRUCTIVE-JAUNDICE IN PATIENTS RECEIVING HEPATIC-ARTERY INFUSIONAL CHEMOTHERAPY - ETIOLOGY, TREATMENT IMPLICATIONS, AND COMPLICATIONS AFTER TRANSHEPATIC BILIARY DRAINAGE

PURPOSE: The authors determined the incidence and cause of obstructive jaundice requiring percutaneous biliary drainage (PBD) occurring in p atients treated with hepatic artery infusional (HAI) chemotherapy. The radiographic findings in the different causes of obstruction are char acterized, and predictors of outcome are identified. MATERIALS AND MET HODS: Charts and radiographs were reviewed for 30 patients who develop ed obstructive jaundice while receiving HAI chemotherapy and who subse quently required biliary drainage, The cause of obstruction, complicat ions related to PBD, and survival from the time of PBD were recorded f or each patient. RESULTS: Of 282 patients treated with HAI chemotherap y, 30 (10.6%) developed obstructive jaundice requiring PBD, Obstructio n was related to chemotherapy-induced biliary sclerosis in 24 patients (80%). Five patients (17%) had bleeding complications related to PBD, Average survival was 32 weeks after biliary drainage, All four patien ts who had bilomas at the time of PBD had been treated with high-dose mitomycin, and lived an average of 10 weeks after the procedure. CONCL USION: Chemotherapy-induced biliary sclerosis is the most common cause of obstructive jaundice in patients receiving HAI chemotherapy, These patients have a higher incidence of bleeding complications and may de velop pseudoaneurysms remote from the ductal puncture site, Developmen t of intrahepatic bilomas is associated with high-dose mitomycin-C tre atment, and the presence of a biloma at the time of PBD is a poor prog nostic indicator.