title: Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer.
abstract: OBJECTIVE
  To compare patterns in mortality and the use of subsequent biliary drainage interventions (surgical, endoscopic, and percutaneous) associated with the different types of biliary bypass.
  
  
  BACKGROUND
  Surgical palliation of obstructive jaundice due to pancreatic cancer is often accomplished with an intestinal bypass to either the gallbladder or the bile duct. It is not known whether a gallbladder bypass, which is a simpler operation and more amenable to laparoscopic surgery, performs as well as a bypass to the bile duct.
  
  
  METHODS
  The authors conducted a retrospective cohort study of 1,919 patients 65 years of age or older who had a surgical biliary bypass for pancreatic cancer diagnosed between 1991 and 1996 using Medicare claims data and the Surveillance, Epidemiology and End Results (SEER) database.
  
  
  RESULTS
  At 1, 2, and 5 years, 7.5%, 17.4%, and 26.0% of 945 patients initially treated with a gallbladder bypass had additional biliary interventions, as compared with 2.9%, 11.0%, and 13.3% of 974 patients initially treated with a bile duct bypass. Patients who initially had a gallbladder bypass were 4.4 times as likely to have additional biliary surgery and 2.9 times as likely to have any subsequent biliary intervention as were patients who initially had a bile duct bypass. Median survival was longer following bile duct bypass. The adjusted hazard ratio for death associated with gallbladder bypass was 1.2.
  
  
  CONCLUSIONS
  Compared to patients whose initial biliary bypass was to the bile duct, the risk of having one or more additional surgical, endoscopic, or percutaneous biliary drainage procedures is substantially greater in patients whose initial bypass was to the gallbladder.
authors.affiliation: Department of Surgery, Toronto General Hospital Research Institute, Ontario, Canada. david.urbach@uhn.on.ca
authors.forename: David R
authors.initials: DR
authors.lastname: Urbach
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome