title: Negative Impact of Preoperative Endoscopic Biliary Drainage on Prognosis of Pancreatic Ductal Adenocarcinoma After Pancreaticoduodenectomy.
abstract: OBJECTIVE
  Patients with obstructive jaundice due to cancer of the pancreatic head often undergo preoperative endoscopic biliary drainage (EBD). The aim of the study was to evaluate the long-term impact of preoperative EBD following pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma.
  
  
  METHODS
  We studied 106 patients who underwent PD for pancreatic ductal adenocarcinoma between May 2000 and November 2013 at the Jikei University Hospital. We retrospectively examined perioperative findings as predictors of prognosis and the relationship between preoperative EBD and recurrence rate as well as overall survival.
  
  
  RESULTS
  In univariate analysis, significant factors associated with poor disease-free survival consisted of the presence of EBD (p=0.0213), poor tumor differentiation (p=0.0023) and tumor-node-metastasis (TNM) classification IV (p=0.0027), while significant factors associated with poor overall survival consisted of the presence of EBD (p=0.0047), poor tumor differentiation (p<0.0001), TNM classification IV (p=0.0031) and microscopic or macroscopic residual tumor (p=0.0184). In multivariate analysis, poor tumor differentiation (p=0.0033) and TNM classification IV (p=0.0020) were independent factors for poor disease-free survival, while the presence of EBD (p=0.0435), poor tumor differentiation (p=0.0009), TNM classification IV (p=0.0447) and microscopic or macroscopic residual tumor (p=0.0184) were independent factors for poor overall survival.
  
  
  CONCLUSIONS
  Preoperative EBD may have a negative impact on prognosis after PD for pancreatic ductal adenocarcinoma.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan k-furukawa@jikei.ac.jp.
authors.forename: Kenei
authors.initials: K
authors.lastname: Furukawa
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shiba
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shirai
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Horiuchi
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Iwase
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Haruki
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takeyuki
authors.initials: T
authors.lastname: Misawa
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D018572:Disease-Free Survival; D004322:Drainage; D004724:Endoscopy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011300:Preoperative Care
keywords: Pancreatic cancer; endoscopic biliary drainage; pancreaticoduodenectomy