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Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma

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Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related deaths in the USA. Although management strategies have evolved, there are continued controversies about the use of neoadjuvant chemotherapy (NAC) and pretreatment biliary drainage (PBD) in patients with resectable and potentially resectable disease.

Aims

We aimed to characterize the practice trends and outcomes for NAC and PBD.

Methods

A single-center cohort study was performed. Electronic medical records were reviewed between 2011 and 2019, and 140 patients who had pancreaticoduodenectomy for PDAC were included. Diagnosis, treatment, and outcome data were captured.

Results

There were no statistically significant temporal trends relating to the use of chemotherapy and PBD. Overall, 41% of patients received NAC and had improved survival, independent of other factors. Of the 71% who received PBD, only 40% had appropriate indications; 30% experienced postprocedure complications, and 34% required reintervention. Factors associated with the application of PBD included preoperative jaundice (OR 70.5, 95% CI 21.4–306.6) and evaluation by non-tertiary therapeutic endoscopists (OR 3.9, 95% CI 1.3–13.6). PBD was associated with a 12-day delay in surgery among those who did not receive NAC (p = 0.005), but there were no differences in surgical complications or mortality.

Conclusions

Our findings suggest that (1) NAC may confer a survival benefit and (2) PBD should be reserved for individuals with jaundice requiring NAC. Implementation of guidelines by North American gastroenterology societies, multidisciplinary treatment models, and delivery of care at high-volume tertiary centers may help optimize management.

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Funding

NIH T32 2T32DK007356-41.

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Authors and Affiliations

  1. Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA

    Saad Saffo, Tamar Taddei & Anil Nagar

  2. Department of Hematology and Oncology, New York University Grossman School of Medicine, New York, NY, USA

    Chengwei Peng

  3. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Ronald Salem

  4. West Haven Veteran Affairs Medical Center, West Haven, CT, USA

    Tamar Taddei & Anil Nagar

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  1. Saad Saffo
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Correspondence to Saad Saffo.

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Saffo, S., Peng, C., Salem, R. et al. Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma. Dig Dis Sci 67, 1409–1416 (2022). https://doi.org/10.1007/s10620-021-06967-7

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  • DOI: https://doi.org/10.1007/s10620-021-06967-7

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