Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage.

Strom, Tobin; Klapman, Jason; Springett, Gregory; Meredith, Kenneth; Hoffe, Sarah; Choi, Junsung; Hodul, Pamela; Malafa, Mokenge; Shridhar, Ravi; Strom, Tobin J; Klapman, Jason B; Springett, Gregory M; Meredith, Kenneth L; Hoffe, Sarah E; Malafa, Mokenge P

<bold>Background: </bold>We evaluated whether preoperative biliary drainage was predictive of recurrence and survival among patients with resectable pancreatic cancer.<bold>Methods: </bold>Patients with pancreatic cancer who were treated with upfront surgery between 2000 and 2012 were identified and stratified by preoperative percutaneous transhepatic cholangiogram-guided drainage (PTBD), placement of endoscopic stents (ERCP), or no biliary drainage (NBD). The primary endpoint was overall survival.<bold>Results: </bold>We identified 193 patients with resectable pancreatic head cancer (33 PTBD; 96 ERCP; and 64 NBD). Key differences between the three groups were more patients who underwent >1 preoperative biliary procedures (p = 0.004) in the PTBD cohort. PTBD patients had a significant increase in hepatic recurrence rate compared with patients who did not undergo PTBD (44.8 vs. 23.3 %, p = 0.02). PTBD patients also had worse overall survival. Median and 5-year survival for PTBD, ERCP, and NBD patients were 17.5 months and 3 %, 22.4 months and 24 %, and 28.9 months and 32 %, respectively (p = 0.002). MVA revealed that percutaneous drainage was an independent predictor of worse overall survival [HR 1.76, 95 % CI (1.05-2.99), p = 0.03].<bold>Conclusions: </bold>Patients with resectable pancreatic cancer who receive PTBD have more advanced disease, higher hepatic recurrence, and worse survival.

PANCREATIC cancer treatment; MEDICAL drainage; ENDOSCOPIC surgery; PREOPERATIVE period; HEALTH outcome assessment; COMPARATIVE studies; CHOLANGIOGRAPHY; CANCER relapse; LIVER tumors; RESEARCH methodology; MEDICAL cooperation; PANCREATIC tumors; PANCREATECTOMY; PREOPERATIVE care; RESEARCH; SURGICAL stents; EVALUATION research; TREATMENT effectiveness; RETROSPECTIVE studies

Surgical Endoscopy & Other Interventional Techniques, 2015, Vol 29, Issue 11, p3273

1866-6817

Academic Journal

10.1007/s00464-015-4075-3