Clinical outcomes of percutaneous transhepatic biliary drainage at different Couinaud's hepatic entry segments for treating obstructive jaundice

Introduction: Percutaneous transhepatic biliary drainage (PTBD) is a common procedure for biliary obstructive jaundice caused by biliary tract obstruction. In clinical practice, PTBD can be carried out at right- or left-sided approach. However, different hepatic entry site may affect success rates and complications. Couinaud classification of liver anatomy further divides the liver into functionally independent segments (segment 2/3, segment 5/6, and segment 7/8). Therefore, this study aimed to elucidate whether different Couinaud hepatic segments as PTBD entry site are associated with high PTBD success and low complications. Methods: A total of 617 patients who underwent PTBD were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to identify entry segments associated with PTBD success, bilirubin reduction, and complications. Results: With higher hepatic segment of PTBD entry site (segment 2/3, 5/6, and 7/8), the trend of PTBD success rate (82.0%, 71.7% and 60.7%; P<0.001) and bilirubin reduction (93.2%, 89.5%, and 82.0%; P=0.012) decreased. Furthermore, PTBD entry at segment 7/8 (42.6%) had highest complication rate than segment 5/6 (6.4%) and 2/3 (9.4%). Univariate and multivariate logistic regression analyses showed that PTBD entry segment was an independent factor associated with PTBD success, bilirubin reduction, and complications. Compared to segment 7/8, segment 2/3 and 5/6 had higher odds of PTBD success (aOR=2.699 and aOR=1.454, respectively) and bilirubin reduction (aOR=3.472 and aOR=2.361, respectively) and associated with lower risk of complications (aOR=0.143 and aOR=0.098, respectively). No independent risk factor for PTBD success and bilirubin reduction were identified in intrahepatic tumors. Moreover, for extrahepatic tumors, PTBD entry at segment 2/3 and segment 5/6 was more likely achieve PTBD success (aOR=3.037 and aOR=1.929, respectively), bilirubin reduction (aOR=3.069 and aOR=3.515) and low complications (aOR=0.102 and aOR=0.126, respectively). Discussion: Good clinical outcomes were observed for PTBD entry at segments 5/6 and 2/3. In contrast, segment 7/8 had the lowest success rate, smallest bilirubin reduction, and the highest complication rate. For patients with obstructive jaundice, PTBD entry in hepatic segments 2/3 and 5/6 is recommended to achieve high success rates and low complications.