Endoscopy 2020; 52(S 01): S88
DOI: 10.1055/s-0040-1704266
ESGE Days 2020 oral presentations
Friday, April 24, 2020 11:00 – 13:00 ERCP: Strictures and leaks Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

TIMING OF PANCREATODUODENECTOMY AFTER BILIARY DRAINAGE IN PATIENTS WITH PERIAMPULLARY CANCER IN THE NETHERLANDS

NCM van Huijgevoort
1   Amsterdam UMC, Department of Gastroenterology & Hepatology, Amsterdam, Netherlands
,
AEJ Latenstein
2   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
TM Mackay
2   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
BA Bonsing
3   Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
,
HC van Santvoort
4   Regional Academic Cancer Center Utrecht, Department of Surgery, Utrecht, Netherlands
,
MJ Bruno
5   Erasmus MC University Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands
,
RC Verdonk
6   Regional Academic Cancer Center Utrecht, Department of Gastroenterology & Hepatology, Utrecht, Netherlands
,
JE van Hooft
1   Amsterdam UMC, Department of Gastroenterology & Hepatology, Amsterdam, Netherlands
,
MG Besselink
2   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
Dutch Pancreatic Cancer Group › Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Obstructive jaundice is a frequent symptom in patients with periampullary cancer. Preoperative biliary drainage (PBD) is indicated in patients with cholangitis, severe jaundice, neoadjuvant chemotherapy and extended waiting time for definitive surgical treatment. Several studies suggest to delay surgery until 4-8 weeks after PBD to allow for recovery of the liver and immune function but consensus is lacking. The aim of this study is to investigate the relation between time from PBD to pancreatoduodenectomy and (major) postoperative outcomes in patients with periampullary cancer.

Methods Anonymized data from patients who underwent pancreatoduodenectomy after PBD for periampullary cancer between Jan 2017 and Dec 2018 were extracted from the mandatory, nationwide, Dutch Pancreatic Cancer Audit. Patients who underwent neoadjuvant therapy prior to pancreatoduodenectomy were excluded from the analysis. Patients were stratified by time from PBD to surgery into group: A; < 4 weeks, B; 4-8 weeks and C; >8 weeks. The primary outcome was the rate of major postoperative complications. Secondary outcomes were the rate of PBD-related complications and overall complications. A logistic regression analysis was performed, adjusted for age, gender, BMI, ASA-score, pancreas texture and pancreatic duct diameter, to assess the association between time from PBD to pancreatectomy and major postoperative complications.

Results In total, 515 patients were included in the analysis (group A 209, group B 216 and group C 90 patients). The rate of PBD-related complications was 18%, with similar outcomes in the groups. The rate of major postoperative complications (Clavien Dindo ≥3) and overall complications were significantly higher in the long drainage group. In multivariable analysis, long duration of PBD was significantly associated with higher risk of major postoperative complications.

Conclusions In a multicenter setting, we found that long drainage duration is associated with the occurrence of major postoperative complications, when it comes to the timing of pancreatoduodenectomy after PBD and complications.