Therapeutic Delay and Survival After Surgery for Cancer of the Pancreatic Head With or Without Preoperative Biliary Drainage

Eshuis, Wietse J.; Gaag, Niels A. van der; Rauws, Erik A.; Eijck, Casper H.J. van; Bruno, Marco J.; Kuipers, Ernst J.; Coene, P. P. L. O.; Kubben, F. J. G. M.; Gerritsen, Josephus J.; Greve, Jan; Gerhards, Michael F.; Hingh, Ignace H. J. T. de; Klinkenbijl, Jean H. G.; Nio, C. Yung; Castro, S. M. M. de; Busch, Olivier R.; Gulik, Thomas M. van; Bossuyt, Patrick M.; Gouma, Dirk J.

doi:10.1097/sla.0b013e3181fd36a2

Cited by 134 publications

(118 citation statements)

References 36 publications

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“…Although only scattered data are available on early outcome after PD following severe post-ERCP pancreatitis [14], there are no reports on late outcome. It seems that preoperative biliary drainage and the delay in surgery do not adversely affect late outcome, with median survival time for resected periampullary adenocarcinoma of 44.7 months [15]. However, the occurrence of complications related to preoperative biliary drainage or surgery was found to be significantly associated with worse survival [15].…”

Section: Discussionmentioning

confidence: 99%

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Skórzewska¹,

Polkowski²

2011

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Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) should have stenting of the biliary system to prevent cholangitis. However, the most serious complication of ERCP is pancreatitis. There are only scattered data on the impact of post-ERCP pancreatitis on the surgical management of periampullary tumours. We report the case of a patient with carcinoma of the ampulla of Vater who underwent preoperative biliary stenting complicated with severe acute pancreatitis and was effectively treated by pylorus preserving pancreaticoduodenectomy (PD) 3 months later. In the postoperative course, grade A pancreatic fistula was observed, with no substantial prolongation of hospital stay. Pathological findings revealed stage II ampullary carcinoma with multiple foci of pancreatic necrosis. Three weeks after the procedure, the patient fully recovered, and started adjuvant chemotherapy. Disease free survival DFS was 27 months and OS 44 months. Pancreaticoduodenectomy can be performed after severe acute necrotizing pancreatitis caused by preoperative biliary stenting, provided adequate timing of surgery is ensured, albeit with the risk of postoperative complications. Even severe post-ERCP pancreatitis should not be regarded as a contraindication for curative PD, especially in patients with periampullary adenocarcinoma, since long-term survival can be achieved. StreszczeniePacjenci poddawani endoskopowej cholangiopankreatografii wstecznej (ECPW) powinni mieć wykonywane protezowanie dróg żółciowych, aby zapobiec zapaleniu dróg żółciowych. Najpoważniejszym jednak powikłaniem po ECPW jest zapalenie trzustki. Dane z piśmiennictwa na temat wpływu zapalenia trzustki po ECPW na postępowanie chirurgiczne u chorych na raka brodawki Vatera są niepełne. Autorzy przedstawiają chorą na raka brodawki Vatera, u której powikłaniem przedoperacyjnego protezowania dróg żółciowych było ciężkie, ostre zapalenie trzustki, które skutecznie leczono wykonaną 3 miesiące później pankreatoduodenektomią (PD) z zachowaniem odźwiernika. W przebiegu pooperacyjnym zaobserwowano wystąpienie przetoki trzustkowej (w stopniu A), bez wpływu na czas hospitalizacji. Wynik badania histopatologicznego potwierdził rozpoznanie raka brodawki Vatera w stadium II z licznymi ogniskami martwicy w obrębie trzustki. Trzy tygodnie po zabiegu pacjentka zakończyła rekonwalescencję pooperacyjną i rozpoczęła chemio terapię uzupełniającą. Przeżycie wolne od objawów choroby wyniosło 27 miesięcy, a przeżycie całkowite 44 miesiące. Pankreatoduodenektomia może być wykonana po ciężkim, ostrym zapaleniu trzustki spowodowanym endoskopowym protezowaniem dróg żółciowych, pod warunkiem podjęcia decyzji o operacji w odpowiednim czasie, z uwzględnieniem ryzyka wystąpie-nia powikłań pooperacyjnych. Nawet ciężkie zapalenie trzustki po ERCP nie powinno być traktowane jako przeciwwskazanie do PD z zamiarem wyleczenia, zwłaszcza u chorych na gruczolakoraka brodawki Vatera, ponieważ stwarza nadzieję na dobry wynik odległy.

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Section: Discussionmentioning

confidence: 99%

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Skórzewska¹,

Polkowski²

2011

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“…A randomised trial of preoperative biliary drainage in pancreatic head tumours did not show any advantage to preoperative stenting 14 and an 'early surgery' policy may also be beneficial in hilar cholangiocarcinoma. The perioperative mortality rate of our group (14%) is difficult to compare with that of other series owing to the low sample size.…”

Section: Discussionmentioning

confidence: 99%

Low rate of active treatment of patients with hilar cholangiocarcinoma

Mishreki

Lim

Cranefield

et al. 2013

annals

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INTRODUCTIONThe results of surgical resection and palliative chemotherapy use in hilar cholangiocarcinoma (HC) have been well publicised but the proportion of patients able to undergo these treatments and the comparative outcomes in a population of patients with HC are less well known. METHODS Patients with HC were identified by review of all patients undergoing percutaneous cholangiography over a nineyear period (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) in a tertiary facility. The treatment undertaken and outcomes were recorded. RESULTS Overall, 68 patients were identified (37 female) with a median age of 70 years. Forty-five (66%) were treated solely by insertion of a metal stent (median survival 4.73 months) and nine (13%) also received palliative chemotherapy (median survival 13.7 months). Persisting jaundice after stent insertion was noted in 18 of 35 patients (51%) tested within one month of death. Fourteen patients (21%) underwent surgical resection (median survival 20.2 months). CONCLUSIONS Patients undergoing surgical resection had significantly longer survival than those receiving only a palliative stent but not compared with those also receiving palliative chemotherapy, with short-term follow-up. Only a third of patients, however, receive active treatment (surgery or chemotherapy) and improvements in long-term biliary palliation are needed.

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“…Conversely, it is obviously excessive if PD is applied for localized adenoma with low-grade dysplasia [1][2][3][4] . In other words, an inappropriate choice of treatment procedure would have a markedly larger impact on the clinical course in patients with ampullary lesions than in patients with early gastric or colonic cancer, both of which are often treated endoscopically [1][2][3][4][16][17][18] ; thus, accurate preprocedural diagnosis is essential for avoiding such an inappropriate choice. However, the reported false-negative rate of endoscopic biopsy for cancer in ampullary lesions is high at 12 60 4,[19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

“…Thus it is difficult to state that EP is an established treatment procedure. In addition, it has been reported that preoperative biliary drainage causes significant fibroproliferative inflammatory changes in bile ducts, making dissection difficult on performing PD 16 and increasing the complication rate after PD [16][17][18] . EP is obviously a more complicated procedure and thus considered to adversely affect the adjacent tissues more than biliary stenting alone, suggesting that PD following ampullectomy could be more technically difficult than PD without prior ampullectomy.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Ability of Diffusion-weighted Magnetic Resonance Imaging to Discriminate Ampullary Neoplasms: A Preliminary Study of 15 Cases

Nagahama

Maruoka

Yamamura

et al. 2014

Showa Univ J Med Sci

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: We assessed the diagnostic capability of diffusion-weighted magnetic resonance imaging DWI to predict the histological diagnosis of ampullary lesions to resolve the diagnostic uncertainty of endoscopic biopsy for ampullary neoplasms. From January 2009 to August 2011, we performed DWI using b values of 0 and 1000 s / mm 2 for 15 patients with a histological diagnosis of ampullary lesion adenocarcinoma, n 8 ; adenoma, n 4 ; hyperplasia, n 3 . We compared the signal intensities determined by comparing signal intensities of ampullary lesions and rating them as markedly hyperintense, hyperintense, or hypo-to-isointense relative to the duodenal wall and the apparent diffusion coef cient ADC, 10 3 mm 2 / s values of the ampullary lesions on DWI among the three groups based on the histological diagnosis. Values are expressed as median range . The cancer-group lesions showed a signi cantly higher signal intensity than either adenoma or hyperplasia markedly hyperintense / hyperintense / hypo-to-isointense ; adenocarcinoma, 7 / 1 / 0 ; adenoma, 0 / 4 / 0 ; hyperplasia, 0 / 0 / 3 ; P 0.005 . The ADC values were signi cantly lower in adenocarcinoma at 1.46 0.83-1.63 than in either adenoma at 2.14 1.92-2.37 or hyperplasia at 2.06 1.88-2.53 P 0.005 . In addition, the ADC values in the malignant group adenocarcinoma were significantly lower than those in the benign groups adenoma and hyperplasia P 0.001 . The ndings suggested that DWI could contribute signi cantly to accurate preprocedural diagnosis of ampullary lesions.

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Therapeutic Delay and Survival After Surgery for Cancer of the Pancreatic Head With or Without Preoperative Biliary Drainage

Abstract: In patients with pancreatic head cancer, the delay in surgery associated with PBD does not impair or benefit survival rate.

Cited by 134 publications

References 36 publications

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Late outcome after pylorus preserving pancreaticoduodenectomy for ampullary carcinoma following severe acute post-stenting pancreatitis: and review of the literature

Low rate of active treatment of patients with hilar cholangiocarcinoma

Diagnostic Ability of Diffusion-weighted Magnetic Resonance Imaging to Discriminate Ampullary Neoplasms: A Preliminary Study of 15 Cases

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