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

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Abstract

Background

We evaluated whether preoperative biliary drainage was predictive of recurrence and survival among patients with resectable pancreatic cancer.

Methods

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.

Results

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].

Conclusions

Patients with resectable pancreatic cancer who receive PTBD have more advanced disease, higher hepatic recurrence, and worse survival.

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Disclosures

Tobin J. Strom, Jason B. Klapman, Gregory M. Springett, Kenneth L. Meredith, Sarah E. Hoffe, Junsung Choi, Pamela Hodul, Mokenge P. Malafa and Ravi Shridhar have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Tobin J. Strom, Sarah E. Hoffe & Ravi Shridhar

  2. Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Jason B. Klapman, Gregory M. Springett, Pamela Hodul & Mokenge P. Malafa

  3. Department of Surgery, University of Wisconsin Hospital and Clinic-Madison, Madison, WI, USA

    Kenneth L. Meredith

  4. Department of Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Junsung Choi

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  1. Tobin J. Strom
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  2. Jason B. Klapman
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  9. Ravi Shridhar
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Correspondence to Ravi Shridhar.

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Strom, T.J., Klapman, J.B., Springett, G.M. et al. Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage. Surg Endosc 29, 3273–3281 (2015). https://doi.org/10.1007/s00464-015-4075-3

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  • DOI: https://doi.org/10.1007/s00464-015-4075-3

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