Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma
Introduction Despite 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 st...
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| Veröffentlicht in: | Annals of surgical oncology 2008-11, Vol.15 (11), p.3138-3146 |
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| creator | Smith, Richard A. Dajani, K. Dodd, S. Whelan, P. Raraty, M. Sutton, R. Campbell, F. Neoptolemos, J. P. Ghaneh, P. |
| description | Introduction
Despite 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.
Methods
155 patients undergoing partial pancreatoduodenectomy for pancreatic ductal adenocarcinoma between January 1997 and August 2007 were identified from a prospectively maintained database.
Results
There 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).
Conclusion
These 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. |
| doi_str_mv | 10.1245/s10434-008-0148-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69719946</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1585360711</sourcerecordid><originalsourceid>FETCH-LOGICAL-c369t-32379b4474be610303ba920dc9dc6cb5a343ebdafecd334f698deb6b3e5e0f903</originalsourceid><addsrcrecordid>eNp1kdtuFSEUhidGYw_6AN4Y4oV3ozAwMFzW2taaGhsP14TDmoaGDVtgdtO-hi8sO3snTZp4BVnr-_-14O-6NwR_IAMbPxaCGWU9xlOPCZv6h2fdIRlbhfGJPG93zKdeDnw86I5KucWYCIrHl90BmcQkJB4Ou7_XGdIasq5-A-gHlBSW6lNEaUZf9RKdt4DOUwjpzscb9MkHr_M9-lkh1m2hyRtSC_qWcgP1Ji1ZmwDoTOfQuCVv_EYH5OPWHGwFh651tBnaRIs-L7a27omDmKzO1se00q-6F7MOBV7vz-Pu9_nZr9Mv_dX3i8vTk6veUi5rTwcqpGFMMAOcYIqp0XLAzkpnuTWjpoyCcXoG6yhlM5eTA8MNhRHwLDE97t7vfNc5_VmgVLXyxUIIOkJaiuJSECkZb-C7J-Bte2Zsu6lhEFSMQtAGkR1kcyolw6zW2a_aZymC1TYutYtLtbjUNi710DRv98aLWYF7VOzzacCwA0prxRvIj5P_7_oPM4ij9w</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>227375773</pqid></control><display><type>article</type><title>Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Smith, Richard A. ; Dajani, K. ; Dodd, S. ; Whelan, P. ; Raraty, M. ; Sutton, R. ; Campbell, F. ; Neoptolemos, J. P. ; Ghaneh, P.</creator><creatorcontrib>Smith, Richard A. ; Dajani, K. ; Dodd, S. ; Whelan, P. ; Raraty, M. ; Sutton, R. ; Campbell, F. ; Neoptolemos, J. P. ; Ghaneh, P.</creatorcontrib><description>Introduction
Despite 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.
Methods
155 patients undergoing partial pancreatoduodenectomy for pancreatic ductal adenocarcinoma between January 1997 and August 2007 were identified from a prospectively maintained database.
Results
There 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).
Conclusion
These 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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-008-0148-z</identifier><identifier>PMID: 18787902</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Aged ; Bilirubin - blood ; Carcinoma, Pancreatic Ductal - pathology ; Carcinoma, Pancreatic Ductal - surgery ; Common Bile Duct - surgery ; Drainage ; Female ; Gastrointestinal Oncology ; Humans ; Jaundice - physiopathology ; Liver Function Tests ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy ; Preoperative Care ; Prognosis ; Prospective Studies ; Stents ; Surgery ; Surgical Oncology ; Survival Rate</subject><ispartof>Annals of surgical oncology, 2008-11, Vol.15 (11), p.3138-3146</ispartof><rights>Society of Surgical Oncology 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c369t-32379b4474be610303ba920dc9dc6cb5a343ebdafecd334f698deb6b3e5e0f903</citedby><cites>FETCH-LOGICAL-c369t-32379b4474be610303ba920dc9dc6cb5a343ebdafecd334f698deb6b3e5e0f903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-008-0148-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-008-0148-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18787902$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Smith, Richard A.</creatorcontrib><creatorcontrib>Dajani, K.</creatorcontrib><creatorcontrib>Dodd, S.</creatorcontrib><creatorcontrib>Whelan, P.</creatorcontrib><creatorcontrib>Raraty, M.</creatorcontrib><creatorcontrib>Sutton, R.</creatorcontrib><creatorcontrib>Campbell, F.</creatorcontrib><creatorcontrib>Neoptolemos, J. P.</creatorcontrib><creatorcontrib>Ghaneh, P.</creatorcontrib><title>Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Introduction
Despite 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.
Methods
155 patients undergoing partial pancreatoduodenectomy for pancreatic ductal adenocarcinoma between January 1997 and August 2007 were identified from a prospectively maintained database.
Results
There 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).
Conclusion
These 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.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged</subject><subject>Bilirubin - blood</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Carcinoma, Pancreatic Ductal - surgery</subject><subject>Common Bile Duct - surgery</subject><subject>Drainage</subject><subject>Female</subject><subject>Gastrointestinal Oncology</subject><subject>Humans</subject><subject>Jaundice - physiopathology</subject><subject>Liver Function Tests</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy</subject><subject>Preoperative Care</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Stents</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kdtuFSEUhidGYw_6AN4Y4oV3ozAwMFzW2taaGhsP14TDmoaGDVtgdtO-hi8sO3snTZp4BVnr-_-14O-6NwR_IAMbPxaCGWU9xlOPCZv6h2fdIRlbhfGJPG93zKdeDnw86I5KucWYCIrHl90BmcQkJB4Ou7_XGdIasq5-A-gHlBSW6lNEaUZf9RKdt4DOUwjpzscb9MkHr_M9-lkh1m2hyRtSC_qWcgP1Ji1ZmwDoTOfQuCVv_EYH5OPWHGwFh651tBnaRIs-L7a27omDmKzO1se00q-6F7MOBV7vz-Pu9_nZr9Mv_dX3i8vTk6veUi5rTwcqpGFMMAOcYIqp0XLAzkpnuTWjpoyCcXoG6yhlM5eTA8MNhRHwLDE97t7vfNc5_VmgVLXyxUIIOkJaiuJSECkZb-C7J-Bte2Zsu6lhEFSMQtAGkR1kcyolw6zW2a_aZymC1TYutYtLtbjUNi710DRv98aLWYF7VOzzacCwA0prxRvIj5P_7_oPM4ij9w</recordid><startdate>20081101</startdate><enddate>20081101</enddate><creator>Smith, Richard A.</creator><creator>Dajani, K.</creator><creator>Dodd, S.</creator><creator>Whelan, P.</creator><creator>Raraty, M.</creator><creator>Sutton, R.</creator><creator>Campbell, F.</creator><creator>Neoptolemos, J. P.</creator><creator>Ghaneh, P.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20081101</creationdate><title>Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma</title><author>Smith, Richard A. ; Dajani, K. ; Dodd, S. ; Whelan, P. ; Raraty, M. ; Sutton, R. ; Campbell, F. ; Neoptolemos, J. P. ; Ghaneh, P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c369t-32379b4474be610303ba920dc9dc6cb5a343ebdafecd334f698deb6b3e5e0f903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged</topic><topic>Bilirubin - blood</topic><topic>Carcinoma, Pancreatic Ductal - pathology</topic><topic>Carcinoma, Pancreatic Ductal - surgery</topic><topic>Common Bile Duct - surgery</topic><topic>Drainage</topic><topic>Female</topic><topic>Gastrointestinal Oncology</topic><topic>Humans</topic><topic>Jaundice - physiopathology</topic><topic>Liver Function Tests</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy</topic><topic>Preoperative Care</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Stents</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Smith, Richard A.</creatorcontrib><creatorcontrib>Dajani, K.</creatorcontrib><creatorcontrib>Dodd, S.</creatorcontrib><creatorcontrib>Whelan, P.</creatorcontrib><creatorcontrib>Raraty, M.</creatorcontrib><creatorcontrib>Sutton, R.</creatorcontrib><creatorcontrib>Campbell, F.</creatorcontrib><creatorcontrib>Neoptolemos, J. P.</creatorcontrib><creatorcontrib>Ghaneh, P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Smith, Richard A.</au><au>Dajani, K.</au><au>Dodd, S.</au><au>Whelan, P.</au><au>Raraty, M.</au><au>Sutton, R.</au><au>Campbell, F.</au><au>Neoptolemos, J. P.</au><au>Ghaneh, P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2008-11-01</date><risdate>2008</risdate><volume>15</volume><issue>11</issue><spage>3138</spage><epage>3146</epage><pages>3138-3146</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Introduction
Despite 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.
Methods
155 patients undergoing partial pancreatoduodenectomy for pancreatic ductal adenocarcinoma between January 1997 and August 2007 were identified from a prospectively maintained database.
Results
There 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).
Conclusion
These 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.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>18787902</pmid><doi>10.1245/s10434-008-0148-z</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2008-11, Vol.15 (11), p.3138-3146 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| subjects | Adenocarcinoma - pathology Adenocarcinoma - surgery Aged Bilirubin - blood Carcinoma, Pancreatic Ductal - pathology Carcinoma, Pancreatic Ductal - surgery Common Bile Duct - surgery Drainage Female Gastrointestinal Oncology Humans Jaundice - physiopathology Liver Function Tests Male Medicine Medicine & Public Health Middle Aged Oncology Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy Preoperative Care Prognosis Prospective Studies Stents Surgery Surgical Oncology Survival Rate |
| title | Preoperative Resolution of Jaundice Following Biliary Stenting Predicts More Favourable Early Survival in Resected Pancreatic Ductal Adenocarcinoma |
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