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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Pancreatic Tumors

Impact of Preoperative Biliary Drainage on Long-Term Survival in Resected Pancreatic Ductal Adenocarcinoma: A Multicenter Observational Study

Authors: Kenichiro Uemura, MD, Yoshiaki Murakami, MD, Sohei Satoi, MD, FACS, Masayuki Sho, MD, FACS, Fuyuhiko Motoi, MD, Manabu Kawai, MD, Ippei Matsumoto, MD, Goro Honda, MD, Masanao Kurata, MD, Hiroaki Yanagimoto, MD, Satoshi Nishiwada, MD, Takumi Fukumoto, MD, Michiakil Unno, MD, Hiroki Yamaue, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Background

This study aimed to evaluate the impact of preoperative biliary drainage (PBD) on the long-term survival of patients with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy (PD).

Methods

A multicenter observational study was performed using a common database of patients with resected PDAC from seven high-volume surgical institutions in Japan.

Results

Of 932 patients who underwent PD for PDAC, 573 (62 %) underwent PBD, including 407 (44 %) who underwent endoscopic biliary drainage (EBD) and 166 (18 %) who underwent percutaneous transhepatic biliary drainage (PTBD). The patients who did not undergo PBD and those who underwent EBD had a significantly better overall survival than those who underwent PTBD, with median survival times of 25.7 months (P < 0.001), 22.3 months (P = 0.001), and 16.7 months, respectively. Multivariate analysis showed that seven clinicopathologic factors, including the use of PTBD but not EBD, were independently associated with poorer overall survival. Furthermore, patients who underwent PTBD more frequently experienced peritoneal recurrence (23 %) than those who underwent EBD (10 %; P < 0.001) and those who did not undergo PBD (11 %; P = 0.001). Multivariate analysis demonstrated that the independent risk factors for peritoneal recurrence included surgical margin status (P < 0.001) and use of PTBD (P = 0.004).

Conclusions

Use of PTBD, but not EBD, was associated with a poorer prognosis, with an increased rate of peritoneal recurrence among patients who underwent PD for PDAC.
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Metadata
Title
Impact of Preoperative Biliary Drainage on Long-Term Survival in Resected Pancreatic Ductal Adenocarcinoma: A Multicenter Observational Study
Authors
Kenichiro Uemura, MD
Yoshiaki Murakami, MD
Sohei Satoi, MD, FACS
Masayuki Sho, MD, FACS
Fuyuhiko Motoi, MD
Manabu Kawai, MD
Ippei Matsumoto, MD
Goro Honda, MD
Masanao Kurata, MD
Hiroaki Yanagimoto, MD
Satoshi Nishiwada, MD
Takumi Fukumoto, MD
Michiakil Unno, MD
Hiroki Yamaue, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4618-9

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