Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2008-09-12

AUTHORS

Richard A. Smith, K. Dajani, S. Dodd, P. Whelan, M. Raraty, R. Sutton, F. Campbell, J. P. Neoptolemos, P. Ghaneh

ABSTRACT

IntroductionDespite the widespread use of endoscopic biliary stenting in patients presenting with potentially resectable pancreatic cancer, there is no general consensus regarding whether this represents a superior management approach over expeditious surgical intervention. The objective of this study was to investigate the influence of preoperative biliary stenting and resolution of jaundice on subsequent postoperative survival following resection for pancreatic cancer.Methods155 patients undergoing partial pancreatoduodenectomy for pancreatic ductal adenocarcinoma between January 1997 and August 2007 were identified from a prospectively maintained database.ResultsThere was no survival difference when comparing patients undergoing preoperative biliary drainage (n = 130) with those who did not (n = 25) (log rank, P = 0.981). When analysing individual prognostic factors as continuous variables in univariate Cox analysis, lower albumin levels (P = 0.016), elevated alkaline phosphatase levels (P = 0.011) and elevated CRP levels (P = 0.021) were associated with poorer overall survival. Multivariable Cox regression demonstrated that both albumin (P = 0.008) and CRP (P = 0.038) remained significant independent predictors of overall survival alongside lymph node ratio (P = 0.018). Although preoperative bilirubin levels were not associated with overall survival when analysed as a continuous variable (Cox, P = 0.786), the presence of jaundice (i.e., bilirubin >35 μmol/l) at the time of surgery was a significant adverse predictor of early survival in patients undergoing preoperative biliary drainage (Breslow–Gehan–Wilcoxon, P = 0.013) and remained a significant predictor of early survival when included in a further Cox analysis with censoring of cases who survived beyond 6 months (Cox, P = 0.017).ConclusionThese results suggest that the presence of jaundice at the time of resection has an adverse impact on early, but not overall, postoperative survival in pancreatic cancer patients undergoing preoperative biliary drainage. More... »

PAGES

3138-3146

Identifiers

URI

http://scigraph.springernature.com/pub.10.1245/s10434-008-0148-z

DOI

http://dx.doi.org/10.1245/s10434-008-0148-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1042885115

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/18787902


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46 alkaline phosphatase levels
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49 biliary drainage
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51 bilirubin levels
52 cancer
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54 cases
55 censoring
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57 continuous variables
58 database
59 differences
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62 early survival
63 elevated CRP levels
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65 expeditious surgical intervention
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73 jaundice
74 levels
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76 lymph
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79 multivariable Cox regression
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91 predictors
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94 preoperative bilirubin level
95 preoperative resolution
96 presence
97 presence of jaundice
98 prognostic factors
99 ratio
100 regression
101 resectable pancreatic cancer
102 resection
103 resolution
104 resolution of jaundice
105 results
106 significant adverse predictors
107 significant independent predictors
108 significant predictors
109 stenting
110 study
111 superior management approach
112 surgery
113 surgical intervention
114 survival
115 survival differences
116 time
117 time of resection
118 time of surgery
119 univariate Cox analysis
120 use
121 variables
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