1. Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer
- Author
-
Latenstein, A.E.J., Mackay, T.M., Huijgevoort, N.C.M. van, Bonsing, B.A., Bosscha, K., Hol, L., Bruno, M.J., Coolsen, M.M.E. van, Festen, S., Geenen, E. van, Koerkamp, B.G., Hemmink, G.J.M., Hingh, I.H.J.T. de, Kazemier, G., Lubbinge, H., Meijer, V.E. de, Molenaar, I.Q., Quispel, R., Santvoort, H.C. van, Seerden, T.C.J., Stommel, M.W.J., Venneman, N.G., Verdonk, R.C., Besselink, M.G., Hooft, J.E. van, Dutch Pancreatic Canc Grp, MUMC+: MA Heelkunde (9), RS: FHML non-thematic output, Graduate School, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Gastroenterology and Hepatology, Gastroenterology & Hepatology, Groningen Institute for Organ Transplantation (GIOT), and Center for Liver, Digestive and Metabolic Diseases (CLDM)
- Subjects
medicine.medical_specialty ,SURGERY ,INTERNATIONAL STUDY-GROUP ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,030230 surgery ,GUIDELINES ,Pancreatic head ,CLASSIFICATION ,PLASTIC STENTS ,Pancreaticoduodenectomy ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Duodenal Neoplasms ,Pancreatic cancer ,medicine ,Periampullary cancer ,Humans ,NEOADJUVANT THERAPY ,Retrospective Studies ,EXPANDING METAL STENTS ,Cholangiopancreatography, Endoscopic Retrograde ,Biliary drainage ,Cholestasis ,Hepatology ,business.industry ,Gastroenterology ,medicine.disease ,EFFICACY ,people.cause_of_death ,Surgery ,Pancreatic Neoplasms ,DEFINITION ,Treatment Outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Extrahepatic biliary obstruction ,Pancreatitis ,Drainage ,Stents ,Radiology ,OBSTRUCTION ,business ,people ,Hospital stay ,Plastics - Abstract
Contains fulltext : 235659.pdf (Publisher’s version ) (Open Access) BACKGROUND: Guidelines advise self-expanding metal stents (SEMS) over plastic stents in preoperative endoscopic biliary drainage (EBD) for malignant extrahepatic biliary obstruction. This study aims to assess nationwide practice and outcomes. METHODS: Patients with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2017-2018). Multivariable logistic and linear regression models were performed. RESULTS: In total, 575/1056 patients (62.0%) underwent preoperative EBD: 246 SEMS (42.8%) and 329 plastic stents (57.2%). EBD-related complications were comparable between the groups (44/246 (17.9%) vs. 64/329 (19.5%), p = 0.607), including pancreatitis (22/246 (8.9%) vs. 25/329 (7.6%), p = 0.387). EBD-related cholangitis was reduced after SEMS placement (10/246 (4.1%) vs. 32/329 (9.7%), p = 0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15-0.87, p = 0.023). Major postoperative complications did not differ (58/246 (23.6%) vs. 90/329 (27.4%), p = 0.316), whereas postoperative pancreatic fistula (24/246 (9.8%) vs. 61/329 (18.5%), p = 0.004; OR 0.50 95%CI 0.27-0.94, p = 0.031) and hospital stay (14.0 days vs. 17.4 days, p = 0.005; B 2.86 95%CI -5.16 to -0.57, p = 0.014) were less after SEMS placement. CONCLUSION: This study found that preoperative EBD frequently involved plastic stents. SEMS seemed associated with lower risks of cholangitis and less postoperative pancreatic fistula, but without an increased pancreatitis risk.
- Published
- 2021