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Severe Jaundice Increases Early Severe Morbidity and Decreases Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

Published on Aug 1, 2015in Journal of The American College of Surgeons4.45
· DOI :10.1016/j.jamcollsurg.2015.03.058
Alain Sauvanet73
Estimated H-index: 73
,
Jean-Marie Boher2
Estimated H-index: 2
(IRD: Institut de recherche pour le développement)
+ 7 AuthorsJean-Robert Delpero23
Estimated H-index: 23
Abstract
Background The influence of jaundice on outcomes after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is debated. This study aimed to determine, in a large multicentric series, the influence of severe jaundice (serum bilirubin level ≥250 μmol/L and 300 μmol/L) on early severe morbidity and survival after PD. Study Design From 2004 to 2009, twelve hundred patients (median age 66 years, 57% male) with resectable PDAC underwent PD. Patients who received preoperative biliary drainage for neoadjuvant treatment or cholangitis were excluded. Pre- and intraoperative data were collected by a standardized form. Serum bilirubin level and creatinine clearance were analyzed as categorical variables. Predictive factors of severe complications and poor survival (Kaplan-Meier method) were identified by univariate and multivariate analysis. Results Median follow-up was 21 months (95% CI, 19-23). Operative mortality was 3.9% (n = 47), with no predictive factors in multivariate analysis. Severe complications (Dindo-Clavien grade III to IV) occurred in 22% (n = 268), with male sex (p = 0.025), America Society of Anesthesiologists score 3 to 4 (p = 0.022), serum bilirubin level ≥300 μmol/L (p = 0.034), and creatinine clearance 2 (p = 0.013) identified as predictive factors in multivariate analysis. Overall 3-year survival rate was 41% (95% CI, 37-45%). In multivariate analysis, serum bilirubin level ≥300 μmol/L (p = 0.048), low-volume center (p Conclusions In this multicentric study, serum bilirubin level ≥300 μmol/L increased severe morbidity and decreased long-term survival after PD for PDAC. These findings suggest that biliary stenting is appropriately indicated before PD in patients with PDAC and severe jaundice.
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  • Citations (23)
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Last.Daniel C. SullivanH-Index: 41
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#1Steven M. Strasberg (WashU: Washington University in St. Louis)H-Index: 66
#2Feng Gao (WashU: Washington University in St. Louis)H-Index: 45
Last.Carolyn Phillips (WashU: Washington University in St. Louis)H-Index: 2
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#1Ching-Wei David Tzeng (UK: University of Kentucky)H-Index: 17
#2Hop S. Tran Cao (University of Texas MD Anderson Cancer Center)H-Index: 15
Last.Huamin Wang (University of Texas MD Anderson Cancer Center)H-Index: 53
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#2Hiroshi Noda (Jichi Medical University)H-Index: 14
Last.Toshiki Rikiyama (Jichi Medical University)H-Index: 7
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#1Florence Jeune (UPMC: Pierre-and-Marie-Curie University)H-Index: 1
#2Romain Coriat (Paris V: Paris Descartes University)H-Index: 26
Last.Sebastien Gaujoux (Paris V: Paris Descartes University)H-Index: 3
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