title: Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage.
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.
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA. tobin.strom@moffitt.org.
authors: Tobin J
authors: TJ
authors: Strom
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Jason B
authors: JB
authors: Klapman
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Gregory M
authors: GM
authors: Springett
authors: Department of Surgery, University of Wisconsin Hospital and Clinic-Madison, Madison, WI, USA.
authors: Kenneth L
authors: KL
authors: Meredith
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
authors: Sarah E
authors: SE
authors: Hoffe
authors: Department of Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Junsung
authors: J
authors: Choi
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Pamela
authors: P
authors: Hodul
authors: Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors: Mokenge P
authors: MP
authors: Malafa
authors: Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA. Ravi0421@yahoo.com.
authors: Ravi
authors: R
authors: Shridhar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
keywords: Biliary drainage; ERCP; PTBD; Pancreatic cancer; Survival
references: Ann Surg Oncol. 2009 Jul;16(7):1751-6
references: 19390900
references: Gastrointest Endosc. 2012 Jul;76(1):67-75
references: 22483859
references: JAMA. 2007 Jan 17;297(3):267-77
references: 17227978
references: Dig Dis Sci. 2013 Jul;58(7):2088-92
references: 23456505
references: Cancer Control. 2008 Oct;15(4):288-94
references: 18813196
references: Ann Surg Oncol. 2010 Apr;17(4):991-7
references: 20108122
references: Ann Surg Oncol. 2011 May;18(5):1319-26
references: 21499862
references: Hepatogastroenterology. 2004 Mar-Apr;51(56):365-7
references: 15086160
references: Gastrointest Endosc. 2011 Aug;74(2):321-327.e1-3
references: 21683354
references: Surg Endosc. 2010 Feb;24(2):423-31
references: 19565296
references: Surg Endosc. 2011 Jul;25(7):2364-7
references: 21373939
references: Eur J Gastroenterol Hepatol. 2000 Oct;12(10):1095-100
references: 11057454
references: N Engl J Med. 2010 Jan 14;362(2):129-37
references: 20071702
references: Cancer Treat Rev. 2007 Apr;33(2):213-21
references: 17157990
references: Ann Surg. 1989 Jun;209(6):708-13; discussion 713-5
references: 2658881
references: Curr Drug Targets. 2012 Jun;13(6):753-63
references: 22458521
references: Br J Cancer. 2012 Jun 5;106(12):1940-4
references: 22617126
references: CA Cancer J Clin. 2013 Jan;63(1):11-30
references: 23335087
references: Dig Dis Sci. 2013 Jun;58(6):1744-50
references: 23179157
references: Cochrane Database Syst Rev. 2012 Sep 12;(9):CD005444
references: 22972086
references: J Hepatobiliary Pancreat Sci. 2011 Sep;18(5):621-9
references: 21667055
references: Hepatobiliary Pancreat Dis Int. 2010 Feb;9(1):65-8
references: 20133232
references: Lancet. 1987 Jul 11;2(8550):57-62
references: 2439854
references: Semin Radiat Oncol. 2014 Apr;24(2):113-25
references: 24635868
references: Hepatogastroenterology. 2009 Jul-Aug;56(93):1194-8
references: 19760968