Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?
Objectives: Whether pre-operative biliary drainage (PBD) affects long-term survival of patients with obstructive jaundice with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy is still controversial. Most of the previous research did not include the important total serum...
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Frontiers Media S.A.
2020-09-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fonc.2020.575316/full |
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| author | Ziyun Shen Ziyun Shen Ziyun Shen Ziyun Shen Jun Zhang Jun Zhang Jun Zhang Jun Zhang Haoda Chen Haoda Chen Haoda Chen Haoda Chen Weishen Wang Weishen Wang Weishen Wang Weishen Wang Wei Xu Wei Xu Wei Xu Wei Xu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Yiran Zhou Yiran Zhou Yiran Zhou Yiran Zhou Shiwei Zhao Shiwei Zhao Shiwei Zhao Shiwei Zhao Zhiwei Xu Zhiwei Xu Zhiwei Xu Zhiwei Xu Xiaxing Deng Xiaxing Deng Xiaxing Deng Xiaxing Deng Jiancheng Wang Jiancheng Wang Jiancheng Wang Jiancheng Wang Yuanchi Weng Yuanchi Weng Yuanchi Weng Yuanchi Weng Baiyong Shen Baiyong Shen Baiyong Shen Baiyong Shen |
| author_facet | Ziyun Shen Ziyun Shen Ziyun Shen Ziyun Shen Jun Zhang Jun Zhang Jun Zhang Jun Zhang Haoda Chen Haoda Chen Haoda Chen Haoda Chen Weishen Wang Weishen Wang Weishen Wang Weishen Wang Wei Xu Wei Xu Wei Xu Wei Xu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Yiran Zhou Yiran Zhou Yiran Zhou Yiran Zhou Shiwei Zhao Shiwei Zhao Shiwei Zhao Shiwei Zhao Zhiwei Xu Zhiwei Xu Zhiwei Xu Zhiwei Xu Xiaxing Deng Xiaxing Deng Xiaxing Deng Xiaxing Deng Jiancheng Wang Jiancheng Wang Jiancheng Wang Jiancheng Wang Yuanchi Weng Yuanchi Weng Yuanchi Weng Yuanchi Weng Baiyong Shen Baiyong Shen Baiyong Shen Baiyong Shen |
| author_sort | Ziyun Shen |
| collection | DOAJ |
| description | Objectives: Whether pre-operative biliary drainage (PBD) affects long-term survival of patients with obstructive jaundice with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy is still controversial. Most of the previous research did not include the important total serum bilirubin (TB) level before intervention as well as before surgery. The aim of this study is to evaluate the impact of PBD on long-term survival after considering the TB level.Methods: Data were collected retrospectively from patients with obstructive jaundice who underwent resection of pancreatic head cancer in a high-volume center. X-Tile software and Kaplan-Meier survival analysis were applied to determine the optimal cut-off levels for TB and age based on the minimal probability (P)-value and the largest χ2-value. Multivariate Cox regression analyses were performed after univariate analysis to assess independent prognostic factors for overall survival (OS) and disease-free survival (DFS).Results: Of 426 patients with obstructive jaundice who underwent pancreaticoduodenectomy for resectable pancreatic head cancer during a 7 year period, 242 (56.8%) received PBD and 184 (43.2%) underwent surgery directly. The OS of patients who received PBD was significantly worse than that of patients who did not receive PBD by univariate analysis (median of 16.6 vs. 22.2 months, P = 0.048). After including liver function parameters in the multivariate Cox regression, we found that the use of PBD was not associated with OS or DFS, while TB before intervention >150 μmol/L was an independent adverse prognostic factor for both OS [hazard ratio (HR), 1.42; 95% CI, 1.05–1.91] and DFS (HR, 1.38; 95% CI, 1.08–1.77).Conclusions: In patients with obstructive jaundice with resectable pancreatic head cancer, undergoing PBD before pancreaticoduodenectomy did not impair or benefit survival rates compared with surgery alone. However, TB before intervention >150 μmol/L predicted an unfavorable prognosis, irrespective of the PBD procedure. |
| first_indexed | 2024-12-17T10:29:05Z |
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| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T10:29:05Z |
| publishDate | 2020-09-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj.art-58ae8024421c464290a44bea46cde3e92022-12-21T21:52:34ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-09-011010.3389/fonc.2020.575316575316Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?Ziyun Shen0Ziyun Shen1Ziyun Shen2Ziyun Shen3Jun Zhang4Jun Zhang5Jun Zhang6Jun Zhang7Haoda Chen8Haoda Chen9Haoda Chen10Haoda Chen11Weishen Wang12Weishen Wang13Weishen Wang14Weishen Wang15Wei Xu16Wei Xu17Wei Xu18Wei Xu19Xiongxiong Lu20Xiongxiong Lu21Xiongxiong Lu22Xiongxiong Lu23Yiran Zhou24Yiran Zhou25Yiran Zhou26Yiran Zhou27Shiwei Zhao28Shiwei Zhao29Shiwei Zhao30Shiwei Zhao31Zhiwei Xu32Zhiwei Xu33Zhiwei Xu34Zhiwei Xu35Xiaxing Deng36Xiaxing Deng37Xiaxing Deng38Xiaxing Deng39Jiancheng Wang40Jiancheng Wang41Jiancheng Wang42Jiancheng Wang43Yuanchi Weng44Yuanchi Weng45Yuanchi Weng46Yuanchi Weng47Baiyong Shen48Baiyong Shen49Baiyong Shen50Baiyong Shen51Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaDepartment of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaInstitute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, ChinaResearch Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaState Key Laboratory of Oncogenes and Related Genes, Shanghai, ChinaObjectives: Whether pre-operative biliary drainage (PBD) affects long-term survival of patients with obstructive jaundice with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy is still controversial. Most of the previous research did not include the important total serum bilirubin (TB) level before intervention as well as before surgery. The aim of this study is to evaluate the impact of PBD on long-term survival after considering the TB level.Methods: Data were collected retrospectively from patients with obstructive jaundice who underwent resection of pancreatic head cancer in a high-volume center. X-Tile software and Kaplan-Meier survival analysis were applied to determine the optimal cut-off levels for TB and age based on the minimal probability (P)-value and the largest χ2-value. Multivariate Cox regression analyses were performed after univariate analysis to assess independent prognostic factors for overall survival (OS) and disease-free survival (DFS).Results: Of 426 patients with obstructive jaundice who underwent pancreaticoduodenectomy for resectable pancreatic head cancer during a 7 year period, 242 (56.8%) received PBD and 184 (43.2%) underwent surgery directly. The OS of patients who received PBD was significantly worse than that of patients who did not receive PBD by univariate analysis (median of 16.6 vs. 22.2 months, P = 0.048). After including liver function parameters in the multivariate Cox regression, we found that the use of PBD was not associated with OS or DFS, while TB before intervention >150 μmol/L was an independent adverse prognostic factor for both OS [hazard ratio (HR), 1.42; 95% CI, 1.05–1.91] and DFS (HR, 1.38; 95% CI, 1.08–1.77).Conclusions: In patients with obstructive jaundice with resectable pancreatic head cancer, undergoing PBD before pancreaticoduodenectomy did not impair or benefit survival rates compared with surgery alone. However, TB before intervention >150 μmol/L predicted an unfavorable prognosis, irrespective of the PBD procedure.https://www.frontiersin.org/article/10.3389/fonc.2020.575316/fullobstructive jaundicepre-operative biliary drainagepancreaticoduodenectomypancreatic cancerlong-term survival |
| spellingShingle | Ziyun Shen Ziyun Shen Ziyun Shen Ziyun Shen Jun Zhang Jun Zhang Jun Zhang Jun Zhang Haoda Chen Haoda Chen Haoda Chen Haoda Chen Weishen Wang Weishen Wang Weishen Wang Weishen Wang Wei Xu Wei Xu Wei Xu Wei Xu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Xiongxiong Lu Yiran Zhou Yiran Zhou Yiran Zhou Yiran Zhou Shiwei Zhao Shiwei Zhao Shiwei Zhao Shiwei Zhao Zhiwei Xu Zhiwei Xu Zhiwei Xu Zhiwei Xu Xiaxing Deng Xiaxing Deng Xiaxing Deng Xiaxing Deng Jiancheng Wang Jiancheng Wang Jiancheng Wang Jiancheng Wang Yuanchi Weng Yuanchi Weng Yuanchi Weng Yuanchi Weng Baiyong Shen Baiyong Shen Baiyong Shen Baiyong Shen Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? Frontiers in Oncology obstructive jaundice pre-operative biliary drainage pancreaticoduodenectomy pancreatic cancer long-term survival |
| title | Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? |
| title_full | Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? |
| title_fullStr | Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? |
| title_full_unstemmed | Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? |
| title_short | Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer? |
| title_sort | does pre operative biliary drainage influence long term survival in patients with obstructive jaundice with resectable pancreatic head cancer |
| topic | obstructive jaundice pre-operative biliary drainage pancreaticoduodenectomy pancreatic cancer long-term survival |
| url | https://www.frontiersin.org/article/10.3389/fonc.2020.575316/full |
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