title: Comparison of clinical outcome and cost-effectiveness after various preoperative biliary drainage methods in periampullary cancer with obstructive jaundice.
abstract: The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 × 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.
authors.affiliation: Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Suk Kyun
authors.initials: SK
authors.lastname: Hong
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
authors.forename: Mee Joo
authors.initials: MJ
authors.lastname: Kang
authors.forename: In Woong
authors.initials: IW
authors.lastname: Han
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000191:economics / Q000601:surgery*; D003362:Cost-Benefit Analysis; D004322:Drainage; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000191:economics / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D011300:Preoperative Care / Q000191:economics*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001663:Bilirubin