Clinical Outcomes and Prognostic Factors of Percutaneous Transhepatic Biliary Drainage in Malignant Biliary Obstruction: A Retrospective Study of 383 Patients

BACKGROUND: Percutaneous transhepatic biliary drainage (PTBD) is a well-established palliative intervention for patients with malignant biliary obstruction, yet outcomes remain heterogeneous across patient populations. A clear understanding of factors influencing survival and complications is essential for optimizing patient selection and procedural strategies. PURPOSE: To evaluate clinical and procedural predictors of outcome in a large single-center cohort of patients undergoing PTBD for malignant biliary obstruction. METHODS: This retrospective study included 383 consecutive patients, who underwent PTBD over a 9-year period at a tertiary referral center. Demographic parameters, underlying malignancy type, laboratory values, procedural details, and post-procedural complications were recorded. Survival outcomes were analyzed using Kaplan-Meier methods and multivariable regression models to identify independent predictors of mortality and complication-related outcomes. RESULTS: Pancreatic cancer (41.5%) and cholangiocarcinoma (30.5%) were the most common etiologies. Post-procedural complications occurred in 33.7% of patients, led by cholangitis (17.8%), and overall, in-hospital mortality was 30.3%. For in-hospital mortality, total bilirubin (AUC: 0.613, P < 0.001), direct bilirubin (AUC: 0.610, P < 0.001), and WBC count (AUC: 0.597, P = 0.002) were significant predictors. The presence of complications (HR: 1.92) and specifically sepsis/septic shock (HR: 3.89) were strongly associated with increased mortality risk. Median in-hospital survival was 62 days, and it was significantly shorter in patients, who developed complications (49 vs. 82 days, P < 0.001). CONCLUSION: PTBD remains an effective and indispensable palliative treatment for malignant biliary obstruction. However, patient outcomes are strongly influenced by baseline clinical status and post-procedural complications.