TY - JOUR
T1 - Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer
AU - Latenstein, Anouk E J
AU - Mackay, Tara M
AU - van Huijgevoort, Nadine C M
AU - Bonsing, Bert A
AU - Bosscha, Koop
AU - Hol, Lieke
AU - Bruno, Marco J
AU - van Coolsen, Marielle M E
AU - Festen, Sebastiaan
AU - van Geenen, Erwin
AU - Groot Koerkamp, Bas
AU - Hemmink, Gerrit J M
AU - de Hingh, Ignace H J T
AU - Kazemier, Geert
AU - Lubbinge, Hans
AU - de Meijer, Vincent E
AU - Molenaar, I Quintus
AU - Quispel, Rutger
AU - van Santvoort, Hjalmar C
AU - Seerden, Tom C J
AU - Stommel, Martijn W J
AU - Venneman, Niels G
AU - Verdonk, Robert C
AU - Besselink, Marc G
AU - van Hooft, Jeanin E
N1 - Funding Information:
The Dutch Pancreatic Cancer Project, including the Dutch Pancreatic Cancer Audit, received funding from the Dutch Cancer Society (KWF Kankerbestrijding; grant no. UVA2013-5842 ).
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/2
Y1 - 2021/2
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85087981080&partnerID=8YFLogxK
U2 - 10.1016/j.hpb.2020.06.009
DO - 10.1016/j.hpb.2020.06.009
M3 - Article
C2 - 32682665
SN - 1365-182X
VL - 23
SP - 270
EP - 278
JO - International Hepato-Pancreato Biliary Association.
JF - International Hepato-Pancreato Biliary Association.
IS - 2
ER -