演題

IS-8-4

A multicenter observational study of potential effect of preoperative biliary drainage on long-term survival in the patients with pancreatic ductal adenocarcinoma

[演者] 上村 健一郎:1
[著者] 村上 義昭:1, 里井 壮平:2, 庄 雅之:3, 元井 冬彦:4, 川井 学:5, 松本 逸平:6, 本田 五郎:7, 倉田 昌直:7, 柳本 泰明:2, 赤堀 宇 広:3, 浅利 貞毅:8, 海野 倫明:4, 山上 裕機:5
1:広島大学応用生命科学部門外科/MSG-PBS(胆膵外科研究グループ), 2:関西医科大学外科/MSG-PBS(胆膵外科研究グループ), 3:奈良県立医科大学消化器・総合外科/MSG-PBS(胆膵外科研究グループ), 4:東北大学肝胆膵外科/MSG-PBS(胆膵外科研究グループ), 5:和歌山県立医科大学第二外科/MSG-PBS(胆膵外科研究グループ), 6:近畿大学外科/MSG-PBS(胆膵外科研究グループ), 7:東京都立駒込病院外科/MSG-PBS(胆膵外科研究グループ), 8:神戸大学肝胆膵外科/MSG-PBS(胆膵外科研究グループ)

OBJECTIVE: To evaluate the impact of preoperative biliary drainage (PBD) on long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy (PD). METHODS: A multicenter observational study was performed using a common database of patients with resected PDAC between 2001 and 2012 from seven high-volume surgical institutions in Japan. RESULTS: Of 932 patients who underwent PD for PDAC, 573 (62%) underwent PBD, including 407 (44%) who underwent endoscopic biliary drainage (EBD) and 166 (18%) who underwent percutaneous transhepatic biliary drainage (PTBD). Patients who did not undergo PBD and those who underwent EBD had a significantly better overall survival compared with those who underwent PTBD, with median survival times of 25.7 months (P<0.001), 22.3 months (P=0.001), and 16.7 months, respectively. Multivariate analysis revealed that seven clinicopathological factors, including use of PTBD but not EBD, were independently associated with poorer overall survival. Furthermore, patients who underwent PTBD more frequently developed peritoneal recurrence (23%) compared with those who underwent EBD (10%, P<0.001) and those who did not undergo PBD (11%, P=0.001). Multivariate analysis demonstrated that independent risk factors for peritoneal recurrence included surgical margin status (P <0.001) and use of PTBD (P=0.004).CONCLUSION: In patients who underwent PD for PDAC, use of PTBD, but not EBD had a negative prognostic impact on overall survival with an increased rate of peritoneal recurrence. These results suggest that PTBD should be avoided whenever possible to maximize overall survival.
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