Compression tumorale des voies biliaires d’origine metastatique: etude retrospective de 62 cas a l’hopital de l’Archet II a Nice en France

Objectifs: Evaluer la frequence et l’etiologie des compressions biliaires d’origine metastatique et analyser l’impact sur la survie de la pose de prothese biliaire. Methodes: Etude retrospective realisee sur 62 patients selectionnes a partir des comptes rendus de 1387 CPRE a l’Unite d’endoscopie de la Federation des maladies de l’appareil digestif au CHU de Nice en France sur une periode de 5 ans. Resultats: Il s’agissait de 38 hommes et 24 femmes d’âge moyen, 65 ans. L’origine de la compression a ete rapportee a des adenopathies pour 55 malades. Des metastases hepatiques etaient presentes dans 22 cas (35,5%) mais seulement 4 parmi eux avaient plus de 3 metastases. Une prothese plastique a ete positionnee dans 14 cas et une prothese metallique dans 48 cas. Les principales etiologies tumorales retrouvees ont ete : le colo-rectum (46,8%), l’estomac (27,4%), et les seins (11,3%). La survie a 1 an etait de 11 ,3%. Il y avait une difference de survie en faveur des sujets porteurs de prothese plastique. Il y avait de meme une difference de survie en faveur des patients n’ayant pas de metastases hepatiques. Un remplacement de prothese plastique par prothese metallique a du etre realise dans 57% des cas, aussi 19 patients ayant beneficie de la pose initiale d’une prothese metallique (39,5%) ont necessite un geste de desobstruction. Conclusion: les cancers du tube digestif representent la principale cause de compression tumorale de la voie biliaire si l’on excepte les tumeurs bilio-pancreatiques. En accord avec les donnees connues de la litterature, les complications secondaires a la pose des protheses sont rares. Cependant une obstruction prothetique par  envahissement tumoral est relativement frequente (1/3 des cas) dans un delai de 3 mois. La survie a 1 an reste faible mais des survies prolongees peuvent s’observer. Mots-cles: compression tumorale-voies biliaires-endoscopie-France English Title:  Biliary tracts compression by metastatic tumor: a retrospective study of 62 cases at the Archet II Hospital in Nice, France English Abstract Objectives: Evaluate the frequency and etiology of metastatic biliary compression and analyze the impact on survival of biliary prosthesis. Methods: Retrospective study performed on 62 patients selected from the reports of 1387 CPRE at the Endoscopy Unit of the Federation of Digestive System Diseases at Nice University Hospital in France over a period of 5 years. Results: There were 38 men and 24 middle-aged women, 65 years old. The origin of compression has been reported in lymphadenopathies for 55 patients. Hepatic metastases were present in 22 cases (35.5%) but only 4 of them had more than 3 metastases. A plastic prosthesis was placed in 14 cases and a metal prosthesis in 48 cases. The main tumor etiologies found were: colo-rectum (46.8%), stomach (27.4%), and breasts (11.3%). Survival at 1 year was 11.3%. There was a difference in survival for subjects with plastic prostheses. There was also a difference in survival in favor of patients without liver metastases. A plastic prosthesis replacement with metal prosthesis had to be performed in 57% of the cases, and 19 patients who had benefited from the initial placement of a metal prosthesis (39.5%) required a clearing gesture. Conclusion: Cancers of the digestive tract are the main cause of tumor compression of the biliary tract, with the exception of bilio-pancreatic tumors. In agreement with known data from the literature, complications secondary to prosthesis placement are rare. However, a prosthetic obstruction by tumor invasion is relatively common (1/3 of the cases) within 3 months. 1-year survival remains low but prolonged survivals may be observed Keywords: tumor compression-biliary tracts-endoscopy-France