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DOI: 10.1055/s-0040-1704268
NATIONWIDE PRACTICE AND OUTCOMES OF ENDOSCOPIC BILIARY DRAINAGE IN RESECTABLE PANCREATIC HEAD AND PERIAMPULLARY CANCER
Publikationsverlauf
Publikationsdatum:
23. April 2020 (online)
Aims International guidelines advise self-expanding metal stents (SEMS) over plastic stents in case preoperative endoscopic biliary drainage (EBD) is indicated in malignant extrahepatic biliary obstruction. This study aims to assess the current nationwide practice and outcomes of EBD in resectable pancreatic head and periampullary cancer.
Methods All patients diagnosed with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy between January 2017 and December 2018 were included from the mandatory Dutch Pancreatic Cancer Audit (17 centers). Multivariable logistic and linear regression models were performed.
Results In total, 575 of 1056 (54.4%%) patients underwent EBD prior to pancreatoduodenectomy. This included 246 (42.8%) SEMS and 329 (57.2%) plastic stents. SEMS placement varied from 0 to 77.1% between pancreatic centers (p< 0.001). EBD-related complications were comparable between SEMS and plastic stents (17.9% vs. 19.5%, p=0.607), including pancreatitis (8.9% vs. 7.6%, p=0.387). EBD-related cholangitis was reduced after SEMS placement (4.1% vs. 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 (23.6% vs. 27.4%, p=0.316), whereas both the rate of postoperative pancreatic fistula (9.8% vs. 18.5%, p=0.004; multivariable analysis: 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; multivariable analysis B -2.86 95%CI -5,16–0.57, p =0.014) were less after SEMS placement.
Conclusions Nationwide performance of EBD was high whereas the use SEMS was low. SEMS was associated with lower risks of cholangitis, less postoperative pancreatic fistula, and a shorter postoperative hospital stay without increased risk of pancreatitis.
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