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 - Dutch Pancreatic Cancer Group
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) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
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 - https://doi.org/10.1016/j.hpb.2020.06.009
DO - https://doi.org/10.1016/j.hpb.2020.06.009
M3 - Article
C2 - 32682665
SN - 1365-182X
VL - 23
SP - 270
EP - 278
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 2
ER -