Frontiers in Oncology (Sep 2020)
Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?
- 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
Affiliations
- Ziyun Shen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ziyun Shen
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Ziyun Shen
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Ziyun Shen
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Jun Zhang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jun Zhang
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Jun Zhang
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jun Zhang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Haoda Chen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Haoda Chen
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Haoda Chen
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Haoda Chen
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Weishen Wang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Weishen Wang
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Weishen Wang
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Weishen Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Wei Xu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wei Xu
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Wei Xu
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wei Xu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Xiongxiong Lu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xiongxiong Lu
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Xiongxiong Lu
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xiongxiong Lu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Yiran Zhou
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yiran Zhou
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Yiran Zhou
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yiran Zhou
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Shiwei Zhao
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shiwei Zhao
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shiwei Zhao
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shiwei Zhao
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Zhiwei Xu
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Zhiwei Xu
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Zhiwei Xu
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Zhiwei Xu
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Xiaxing Deng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xiaxing Deng
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Xiaxing Deng
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Xiaxing Deng
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Jiancheng Wang
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jiancheng Wang
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Jiancheng Wang
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Jiancheng Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Yuanchi Weng
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yuanchi Weng
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Yuanchi Weng
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Yuanchi Weng
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- Baiyong Shen
- Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Baiyong Shen
- Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China
- Baiyong Shen
- Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Baiyong Shen
- State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
- DOI
- https://doi.org/10.3389/fonc.2020.575316
- Journal volume & issue
-
Vol. 10
Abstract
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.
Keywords
- obstructive jaundice
- pre-operative biliary drainage
- pancreaticoduodenectomy
- pancreatic cancer
- long-term survival
