Recently, I have come across many patients with jaundice occurring in advanced tumors, mostly due to advanced gastric cancer, pancreatic cancer, gallbladder cancer or bile duct cancer. Some of them are inoperable, and some of them have lymph node metastasis after surgery, resulting in bile duct compression and thus bile duct obstruction, which manifests as obstructive jaundice, with symptoms of generalized yellowing of the skin, yellow urine, yellow eyes, and generalized itching of the skin. Due to the obstruction of the bile ducts, it can cause damage to liver function, elevated blood bilirubin, in some cases up to 20 times the normal value, and elevated blood transaminases. If left untreated, it will further cause liver failure and accelerate the development of the disease and death. For patients with advanced tumors, excluding patients with pancreatic head cancer and bile duct cancer, most of them are unable to remove the metastatic lymph nodes surgically or have no value for surgical removal. The treatment at this time is to improve the patient’s quality of life and prolong the patient’s survival time. Therefore, it is more appropriate to use less invasive methods to drain the bile rather than more invasive surgery. We often use a method that involves puncturing the liver through the skin and placing a drainage tube into the bile ducts inside the liver to drain the bile outside the body. In this way, the bile has an outlet and liver function will improve. If the bile duct obstruction is not complete, a biliary stent can be placed at the same time to open the narrowed bile duct, which can help to relieve the obstruction. However, this is not often possible, and many patients come to us with a complete blockage of the bile duct, so that the guide wire cannot be lowered and therefore no stent can be placed. For those who cannot have a stent placed in one stage, a biliary drain can be placed first, and after the liver function improves, radiotherapy or chemotherapy around the hepatoportal and bile duct can be performed, so that the patient’s biliary compression will improve after the treatment and the obstruction of the lower bile duct can be reopened. At this time, the lower bile duct can be dilated and a stent can be placed to open up the narrowing of the lower bile duct, and then the drainage tube can be removed, and the patient’s quality of life will be improved. I had a patient with gallbladder cancer, an old lady, who was found to have tumor invasion of the lower bile duct intraoperatively and could not be removed surgically, so after palliative tumor removal, external biliary drains were placed and postoperative radiotherapy was given. However, not all patients with biliary obstruction can undergo this puncture and external bile duct drainage procedure. Some patients with extensive abdominal implant metastases and cancerous ascites are not suitable and are contraindicated for biliary drainage surgery. If forcible puncture and drainage is performed at this time, it may produce bilious peritoneum after surgery and aggravate the development of the disease, which is even worse than not performing puncture surgery. Therefore, the choice of indications should be made with certainty. However, one should not be too hopeful about this procedure. It is a palliative treatment to relieve the symptoms of biliary obstruction, improve liver function, and provide an opportunity for subsequent radiotherapy, chemotherapy or other treatments. Its procedure itself has no therapeutic effect on the tumor and thus does not slow down the growth and metastatic invasion of the tumor, and therefore, it does not necessarily improve the course of the tumor. I have seen some patients who did not take follow-up treatment after bile duct drainage and improvement of liver function because they were worried about the damage of radiotherapy or chemotherapy, and the tumor progressed and became life-threatening in about 3 months. It is also important to avoid violent vomiting or coughing after biliary puncture and drainage to prevent the slippage of the drainage tube. Since the external part of the drainage tube is fixed on the skin, while the part inside the intrahepatic bile duct can only be relatively fixed by the pigtail-like curvature of the drainage tube, thus it is easy to slip out. It is also important to pay attention to whether the catheter is blocked or ruptured. If the catheter slips out, it needs to be seen in the hospital and reintubated if necessary. One of my patients was reintubated three times and survived with the tube for more than six months after surgery. Patients with external bile drainage should also pay attention to potassium and sodium supplementation because the salt contained in bile will be lost with the drainage of bile and needs to be replenished exogenously, and they should eat saltier food. Overall, for biliary obstruction in advanced cancer patients, external biliary drainage can be considered when necessary to improve the quality of life, improve liver function and provide a chance for subsequent treatment, which can extend survival to some extent.