• Annals of surgery · Dec 2023

    Biliary Adverse Events during Neoadjuvant Therapy for Pancreatic Cancer.

    • Sam Z Thalji, Deemantha Fernando, Kulwinder S Dua, Srivats Madhavan, Phillip Chisholm, Zachary L Smith, Mohammed Aldakkak, Kathleen K Christians, Callisia N Clarke, Ben George, Mandana Kamgar, Beth A Erickson, William A Hall, Douglas B Evans, and Susan Tsai.
    • Division of Surgical Oncology, Department of Surgery, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI.
    • Ann. Surg. 2023 Dec 1; 278 (6): e1224e1231e1224-e1231.

    ObjectiveTo describe a high-volume experience with biliary drainage before neoadjuvant therapy (NAT) for patients with operable pancreatic cancer (PC) and characterize the association between biliary adverse events (BAEs) and patient outcome.BackgroundPatients with PC presenting with biliary obstruction require durable decompression before NAT.MethodsPatients with operable PC and tumor-associated biliary obstruction were examined and grouped by the presence or absence of a BAE during NAT. The incidence, timing, and management of BAEs are described, and outcomes, including the completion of all treatment and overall survival (OS), were compared.ResultsOf 426 patients who received pretreatment biliary decompression, 92 (22%) experienced at least 1 BAE during NAT, and 56 (13%) required repeat intervention on their biliary stent. The median duration of NAT was 161 days for all patients and was not different in the group that experienced BAEs. The median time from initial stent placement to BAE was 64 days. An interruption in the delivery of NAT (median 7 days) occurred in 25 (6%) of 426 patients. Among 426 patients, 290 (68%) completed all NAT, including surgery: 60 (65%) of 92 patients with BAE and 230 (69%) of 334 patients without BAE ( P =0.51). Among 290 patients who completed NAT and surgery, the median OS was 39 months, 26 months for the 60 patients with BAE, and 43 months for the 230 patients without BAE ( P =0.02).ConclusionsDuring extended multimodal NAT for PC, 22% of patients experienced a BAE. Although BAEs were not associated with a significant interruption of treatment, patients who experienced a BAE had worse OS.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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