Tesis

Kesintasan 6 Bulan Pasien Striktur Bilier Distal Maligna Pasca Stent Bilier per Endoskopik dan Faktor-Faktor yang Berpengaruh = Six Months Survival Post Endoscopic Billiary Stent of Malignant Distal Biliary Stricture Patients and the Associated Factors

Latar Belakang: Striktur bilier distal maligna seringkali didiagnosis pada stadium lanjut (unresectable) dan memerlukan pemasangan stent bilier per endoskopik. Angka kesintasan pasca tindakan stent bilier per-endoskopik dan faktor-faktor yang memengaruhinya belum ada di Indonesia. Tujuan: Mengetahui kesintasan pasien striktur bilier distal maligna pasca pemasangan stent bilier per endoskopik dan faktor-faktor yang berpengaruh. Metode: Penelitian kohort retrospektif dari rekam medik pasien kanker kaput pankreas, atau kanker ampulla/papilla Vateri, atau kolangiokarsinoma distal, dengan striktur bilier distal pasca stent bilier per endoskopik di RSUPN-CM pada Juni 2015– Agustus 2017. Kesintasan kumulatif dinyatakan dengan Kurva Kaplan-Meier. Analisis bivariat dan multivariat dilakukan dengan regresi Cox terhadap faktor-faktor kegagalan pemasangan stent, adanya perdarahan, sepsis, komorbid, malnutrisi, dan kadar albumin serum. Hasil: Dari 144 pasien dewasa dengan striktur bilier distal maligna yang dipasang stent bilier per endoskopik, terdapat 120 subjek yang masuk kriteria inklusi. Proporsi kesintasan 6 bulan adalah sebesar 24 % subjek penelitian, dengan median kesintasan 81 hari (IK 95% : 56 – 106 hari). Faktor komorbid, sepsis, malnutrisi, dan albumin ≤ 3,0 g/dL memiliki nilai p < 0,25 pada analisis bivariat. Hasil analisis multivariat menunjukkan bahwa kadar albumin ≤ 3,0 g/dL memiliki risiko sebesar 2,73 kali (IK95% 1,48–5.05, nilai p 0,001) terhadap mortalitas 6 bulan pasca stent. Simpulan: Median kesintasan 6 bulan pasien striktur bilier distal maligna pasca stent bilier per endoskopik adalah 81 hari, dengan proporsi sebesar 24% subjek bertahan hidup. Kadar albumin serum ≤ 3,0 g/dL merupakan faktoryang memiliki hubungan bermakna secara statistik terhadap kesintasan 6 bulan.
Kata Kunci: Kesintasan, striktur bilier distal maligna, stent bilier per endoskopik, faktor terkait mortalitas, albumin.


Background. Malignant distal biliary stricture often diagnosed at advanced stage (unresectable) and requires endoscopic biliary stent placement. Indonesia has no data about the survival of these patients after the procedure and its associated factors. Objectives. To obtain survival rate and mortality-related factors of malignant distal biliary strictures post endoscopic biliary stents placement. Methods. A retrospective cohort study was conducted using medical records of caput pancreas or ampulla/papilla Vateri carcinoma or distal cholangiocarcinoma patients, with distal biliary stricture and underwent endoscopic biliary stent insertion in June 2015–August 2017 at Cipto Mangunkusumo Hospital. Six months cumulative survival was expressed by Kaplan-Meier curve. Bivariate and multivariate Cox regression analyzes were performed on the factors of: biliary stent insertion failure, bleeding, sepsis, comorbidities, malnutrition, and serum albumin levels. Results. Total 120 out of 144 subjects were enrolled in this study. Six months cumulative survival was 24 %, with median survival 81 days (CI 95% is 56–106 days). Factors of Charlson comorbid score ≥4, sepsis, malnutrition and albumin serum level ≤ 3.0 g/dL had p value < 0.25 in bivariate analysis. The multivariate analysis showed that low albumin serum levels (≤ 3.0 g/dL) has greater risk to death with hazard ratio 2.73 (CI 95% 1.485.05, p value 0.001). Conclusion. The median survival of malignant distal biliary stricture post endoscopic biliary stent was 81 days, with only 24% subjects survived 6-months after the procedure. The factors that statistically significant related to the 6 months survival were serum albumin levels ≤ 3.0 g/dL.
Keywords: survival, malignant distal biliary stricture, endoscopic biliary stent, mortality related factors, albumin