Biliary intervention rates during neoadjuvant therapy for adenocarcinoma of the pancreatic head.
Biliary intervention rates during neoadjuvant therapy for adenocarcinoma of the pancreatic head.
复制标题
胰头腺癌新辅助治疗期间的胆道干预率。
DOI：
10.1016/j.hpb.2020.11.1147
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Hughes,StevenJ
中科院分区：
文献类型：
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作者：
Kirkpatrick,Stacey;Gillies,Gwendolyn;Underwood,Patrick;Cioffi,Jessica;Trevino,JoseG;Hughes,StevenJ
背景胰头腺癌切除前的新辅助治疗会增加手术时间，从而增加发生胆道并发症的可能性。我们假设新辅助治疗期间的胆道并发症会对临床结果产生负面影响。方法我们对 2014 年 5 月至 2019 年 3 月持续接受新辅助治疗的临界可切除患者队列进行了回顾性研究。胆道并发症定义为新发胆道梗阻、现有支架失效、胆囊炎和胆管炎。 59 名符合纳入标准的患者中，34 名（57.6%）继续接受切除术。胆道并发症影响 16 名患者 (27%)；其中 8 名（50%）患者继续接受手术切除。在这 43 名未接受胆道干预的患者中，26 名继续接受手术切除（60.4%）。胆道并发症对化疗周期总数 (p = 0.12)、手术切除 (p = 0.56) 或中位生存期 (p = 0.23) 没有显着影响。在进行手术的患者中，需要胆道干预的患者的中位生存期存在显着差异（17.9 个月与 31.0 个月），但未达到显着性 (p = 0.35)。 结论 胰腺腺癌新辅助治疗期间需要进一步胆道干预很常见，但似乎对新辅助治疗或治疗的周期数没有显着影响。 进行手术切除。需要进行更大规模的研究来确定这些事件是否会影响总体生存。
BackgroundNeoadjuvant therapy prior to resection of adenocarcinoma of the pancreatic head increases time to surgery and thus the possibility of biliary complications. We hypothesized that biliary complications during neoadjuvant therapy negatively impact clinical outcomes.MethodsWe completed a retrospective study of a cohort of borderline resectable patients consistently treated with neoadjuvant therapy from May 2014 through March 2019. Biliary complications were defined as new-onset biliary obstruction, existing stent failure, cholecystitis, and cholangitis.ResultsOf 59 patients that met inclusion criteria, 34 (57.6%) went on to resection. Biliary complications affected 16 patients (27%); 8 (50%) of these patients went on to surgical resection. Of those 43 patients who did not have a biliary intervention, 26 went on to surgical resection (60.4%). There was no significant effect of a biliary complication on total number of chemotherapy cycles (p = 0.12), proceeding to surgical resection (p = 0.56) or on median survival (p = 0.23). Among patients who did proceed to surgery, there was a notable difference in median survival for patients who required a biliary intervention (17.9 vs 31.0 months) that did not reach significance (p = 0.35).ConclusionThe need for further biliary interventions during neoadjuvant therapy for pancreatic adenocarcinoma is common, but does not appear to have a significant effect on number of cycles of neoadjuvant therapy or proceeding to surgical resection. Larger studies are necessary to determine if these events compromise overall survival.