Worse Overall Survival With Preoperative Biliary Drainage in Resectable Pancreatic Cancer Patients

2014 ◽  
Vol 90 (1) ◽  
pp. S354 ◽  
Author(s):  
T. Strom ◽  
G.M. Springett ◽  
K.L. Meredith ◽  
S.E. Hoffe ◽  
J.B. Klapman ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer

Overall survival with preoperative biliary drainage in patients with resectable pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 314-314
Author(s):  
Tobin Joel Crill Strom ◽  
Sarah E. Hoffe ◽  
Shivakumar Vignesh ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Size ◽  
Biliary Drainage ◽  
Cox Regression ◽  
Neoadjuvant Treatment ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer ◽  
Pathologic Features

314 Background: Resectable pancreatic cancer patients often present with obstructive jaundice necessitating the placement of biliary stents or percutaneouse drainage catheters. We sought to evaluate whether preoperative biliary drainage affects recurrence and survival. Methods: An IRB-approved study was conducted on our institutional tumor registry to identify pancreatic cancer patients who were treated with upfront surgery between 2000 and 2012. Patients were then stratified by preoperative use of endoscopically placed stents (ERCP), percutaneous catheters (PTC), or no biliary drainage (NBD). The primary endpoint was overall survival (OS). Survival curves were calculated using the Kaplan-Meier method and the log-rank test. Multivariate analysis (MVA) was performed with a Cox regression model. Results: We identified 202 patients for the study (21 PTC; 89 ERCP; 92 NBD). Key differences between the 3 groups were mean pathologic tumor size (p=0.005), pathologic T3/4 (p =0.01), and pathologic N1 (p=0.007) status, with more aggressive pathologic features in PTC patients. PTC patients had a non-significant increase in rate of hepatic recurrences compared with ERCP and NBD patients (47.4% vs. 26.6% vs. 28.7%, respectively; p=0.20). PTC patients also had worse median and 3 year survival (21 months and 16%) compared to ERCP (23.3 months and 39%) and NBD patients (29 months and 45%, p=0.02). MVA revealed that PTC was an independent predictor of worse overall survival (HR 2.3[95% CI 1.3-4.0], p=0.005), along with pathologic tumor size (HR 1.1[1.0-1.3], p=0.008), nodes positive (HR 1.1[1.1-1.2], p=0.001), and post-operative CA19-9 >90 (HR 2.6[1.5-4.4], p=0.001). Conclusions: Patients with resectable pancreatic cancer who require a pre-operative PTC drain had a non-significant increase in hepatic recurrence rate and worse overall survival than patients who either had an ERCP stent placed or no biliary decompression prior to surgery. Given their worse prognosis, patients who require PTC placement might also benefit from neoadjuvant treatment with restaging prior to surgery.

Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

Gut ◽  
2015 ◽  
Vol 65 (12) ◽  
pp. 1981-1987 ◽  
Author(s):  
J A M G Tol ◽  
J E van Hooft ◽  
R Timmer ◽  
F J G M Kubben ◽  
E van der Harst ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Plastic Stents ◽  
Resectable Pancreatic Cancer

scholarly journals Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Tomofumi Tsuboi ◽  
Tamito Sasaki ◽  
Masahiro Serikawa ◽  
Yasutaka Ishii ◽  
Teruo Mouri ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Metallic Stents ◽  
Plastic Stents ◽  
Complication Rates ◽  
Metallic Stent ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Hospitalization Costs

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC).Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery.Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p=0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test,p=0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery.Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

scholarly journals Preoperative biliary drainage in resectable pancreatic cancer: a systematic review and network meta-analysis

HPB ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 477-486 ◽  
Author(s):  
Peter J. Lee ◽  
Amareshwar Podugu ◽  
Dong Wu ◽  
Arier C. Lee ◽  
Tyler Stevens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Meta Analysis ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer

Sa1440 Preoperative Biliary Drainage in Resectable Pancreatic Cancer: A Systematic Review and Network Meta-Analysis

2017 ◽  
Vol 85 (5) ◽  
pp. AB242-AB243
Author(s):  
Peter Junwoo Lee ◽  
Amareshwar Podugu ◽  
Dong Wu ◽  
Arier Chi Lun Lee ◽  
Tyler Stevens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Meta Analysis ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer

scholarly journals Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

2021 ◽  
pp. 1-9
Author(s):  
Sarah Blacker ◽  
Rajiv P. Lahiri ◽  
Mary Phillips ◽  
Graham Pinn ◽  
Tim D. Pencavel ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer

Association of RecQ1 A159C polymorphism with overall survival of patients with resected pancreatic cancer: A replication study in RTOG 9704.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 156-156 ◽  
Author(s):  
D. Li ◽  
J. Moughan ◽  
C. H. Crane ◽  
J. P. Hoffman ◽  
W. Regine ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Surgical Margin ◽  
Cox Proportional Hazards Model ◽  
Tumor Diameter ◽  
Genotype Distribution ◽  
Resectable Pancreatic Cancer ◽  
Dna Repair Gene ◽  
Significant Difference

156 Background: To confirm whether a previously observed association between a DNA repair gene and clinical outcome of resectable pancreatic cancer patients treated with preoperative chemoradiation is reproducible in another patient population. Methods: We evaluated the RecQ1 A159C variant (rs13035) in patients with resected pancreatic cancer who were enrolled on the RTOG 9704 trial of 5FU-based chemoradiation preceded and followed by 5-FU or gemcitabine. DNA was extracted from paraffin-embedded tissue sections and genotype was determined using the Taqman method. A multivariate Cox proportional hazards model was used to determine if there is a correlation between genotype and overall survival (OS). Models were built using the stepwise selection procedure. The following variables were included in the model: genotype, treatment arm, age, gender, race, nodal involvement, tumor diameter, and surgical margin status. Results: A total of 154 out of 451 eligible patients were evaluated for the RecQ1genotype. There was no significant difference in baseline characteristics and overall survival time between patients who were and were not evaluated for the RecQ1genotype. In the 154 evaluated patients, the genotype distribution followed the Hardy-Weinberg Equilibrium, i.e. 37% had genotype AA, 43% AC, and 20% CC. The RecQ1 variant AC/CC genotype carriers were more likely to be node positive compared to the AA carrier (p=0.03). The median survival times (95% C.I.) for AA, AC, and CC carriers were 1.72 (1.36, 2.17), 1.57 (1.18, 1.80), and 1.18 (0.86, 1.75) years, respectively. On multivariate analysis, patients with the AC/CC genotypes were more likely to die than patients with AA genotype (HR=1.54, 95% C.I. = [1.07, 2.23], p=0.022). This effect is more definitive for patients on the 5-FU arm (n=82) (HR=1.64, 95% C.I. = [0.99, 2.70], p=0.055) than for patients on the gemcitabine arm (n=72, HR=1.46, 95% C.I. = [0.81, 2.63], p=0.21). Conclusions: Results of this study suggest that the RecQ1 A159C genotype is a prognostic or predictive factor for resectable pancreatic cancer patients who are treated with adjuvant chemoradiation. No significant financial relationships to disclose.

Association of decline in serum Ca19-9 after neoadjuvant therapy with improved survival among borderline resectable pancreatic cancer patients.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e15082-e15082 ◽  
Author(s):  
Susan Tsai ◽  
Anna Mahmoud ◽  
Ben George ◽  
Tracy R. Kelly ◽  
Paul S. Ritch ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Neoadjuvant Therapy ◽  
Cancer Patients ◽  
Response To Therapy ◽  
Proportional Hazard ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Cox Proportional Hazard ◽  
Localized Disease

e15082 Background: Serum Ca19-9 (19-9) decline in response to therapy has been associated with an increased overall survival in metastatic pancreatic cancer patients (pts). However, the prognostic value of a 19-9 decline after neoadjuvant therapy in pts with localized disease is less well defined. Methods: We evaluated 73 pts with NCCN defined BRPC who received neoadjuvant therapy with induction chemotherapy (CRX) followed by chemoradiation (CRT). Staging with CT and 19-9 was obtained at three defined time points: baseline (bilirubin normal), after CRX, and following CRT (pre-surgical). Change in 19-9 (δ19-9) was defined as: (baseline 19-9- pre-surgical 19-9)/baseline 19-9. δ19-9 was classified as: absent (δ19-9<0) or minimal (0 <δ19-9<0.25), low (0.25<δ19-9<0.50), moderate (0.50<δ19-9<0.75), high (δ19-9> 0.75). Results: Of the 73 pts, 20 pts had normal/undetectable 19-9 and were excluded from the analysis. Of the remaining 53 pts, mean 19-9 levels at baseline, after CRX, and after CRT were 956, 164, and 139 U/mL, respectively. The mean change in 19-9 after CRX was 44%. Changes in 19-9 after CRX correlated with continued decline in 19-9 after CRT (Spearman rho = 0.81, p<0.001). δ19-9 was high in 38 (71%), moderate in 9 (17%), min/low in 1 (2%), and absent in 5 (9%). Of the 53 pts, 49 (92%) were considered for surgery after neoadjuvant therapy and 38 (72%) underwent pancreatectomy. In a multivariate logistic regression, higher δ19-9 was associated with a 5.4 fold increased odds of completing all neoadjuvant therapy including surgery as compared to pts with no change in 19-9 (absent δ19-9; HR 5.4, p=0.12). Patients with absent δ19-9 had a worse overall survival than pts with minimal to high δ19-9 (median survival 11.5 mo vs. 30.1 mo, p = 0.0002). In a multivariate Cox proportional hazard, a decline in pre-surgical 19-9 from baseline was associated with improved survival (HR 0.21, p =0.02). Conclusions: Following neoadjuvant therapy, a decline in 19-9 is associated with surgical resection and improved overall survival. An increase in 19-9 above baseline (the absent δ19-9 group) prior to surgery is a poor prognostic marker and such patients may benefit from additional systemic therapy.

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