Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage.

Abstract:

OBJECTIVE:To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. BACKGROUND:Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of surgery can lead to more advanced cancer stages at surgical exploration, affecting resection rate and survival. METHODS:We conducted a multicenter, randomized controlled clinical trial to compare PBD with early surgery (ES) for pancreatic head cancer for complications. We obtained Kaplan-Meier estimates of overall survival for patients with pathology-proven malignancy and compared survival functions of ES and PBD groups using log-rank test statistics. Multivariable Cox regression analyses were performed to evaluate the prognostic role of time to surgery for overall survival. RESULTS:Mean times from randomization to surgery were 1.2 (0.9-1.5) and 5.1 (4.8-5.5) weeks in the ES and PBD groups, respectively (P < 0.001). In the ES group, 60 (67%) of 89 patients underwent resection, versus 53 (58%) of 91 patients in the PBD group (P = 0.20). Median survival after randomization was 12.2 (9.1-15.4) months in the ES group versus 12.7 (8.9-16.6) months in the PBD group (P = 0.91). A longer time to surgery was significantly associated with slightly lower mortality rate after surgery (hazard ratio = 0.90, 95% CI, 0.83-0.97), when taking into account resection, bilirubin, complications, pancreatic adenocarcinoma, tumor-positive lymph nodes, and microscopically residual disease. CONCLUSIONS:In patients with pancreatic head cancer, the delay in surgery associated with PBD does not impair or benefit survival rate.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Eshuis WJ,van der Gaag NA,Rauws EA,van Eijck CH,Bruno MJ,Kuipers EJ,Coene PP,Kubben FJ,Gerritsen JJ,Greve JW,Gerhards MF,de Hingh IH,Klinkenbijl JH,Nio CY,de Castro SM,Busch OR,van Gulik TM,Bossuyt PM,Gouma DJ

doi

10.1097/SLA.0b013e3181fd36a2

subject

Has Abstract

pub_date

2010-11-01 00:00:00

pages

840-9

issue

5

eissn

0003-4932

issn

1528-1140

pii

00000658-201011000-00016

journal_volume

252

pub_type

杂志文章,多中心研究,随机对照试验
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    更新日期:1977-01-01 00:00:00

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    pub_type: 杂志文章

    doi:

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