A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified

Mezhir, James J.; Brennan, Murray F.; Baser, Raymond E.; D’Angelica, Michael I.; Fong, Yuman; DeMatteo, Ronald P.; Jarnagin, William R.; Allen, Peter J.

doi:10.1007/s11605-009-1046-9

Cited by 109 publications

(80 citation statements)

References 26 publications

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“…However, biliary decompression in those without symptomatic hyperbilirubinemia receiving upfront surgery may be avoided. [25][26][27] MRI/magnetic resonance cholangiopancreatography is considered to be equivalent to EUS/ERCP in the diagnostic setting.…”

Section: Imaging Evaluationsmentioning

confidence: 99%

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Tempero

Malafa

Al-Hawary

et al. 2017

J Natl Compr Canc Netw

922

897

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OverviewPancreatic cancer is one of the most common causes of cancer-related death among men and women in the United States. Abstract Ductal adenocarcinoma and its variants account for most pancreatic malignancies. High-quality multiphase imaging can help to preoperatively distinguish between patients eligible for resection with curative intent and those with unresectable disease. Systemic therapy is used in the neoadjuvant or adjuvant pancreatic cancer setting, as well as in the management of locally advanced unresectable and metastatic disease. Clinical trials are critical for making progress in treatment of pancreatic cancer. The NCCN Guidelines for Pancreatic Adenocarcinoma focus on diagnosis and treatment with systemic therapy, radiation therapy, and surgical resection. J Natl Compr Canc Netw 2017;15(8):1028-1061 doi: 10.6004/jnccn.2017 NCCN Categories of Evidence and Consensus Please NoteThe These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Section: Imaging Evaluationsmentioning

confidence: 99%

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Tempero

Malafa

Al-Hawary

et al. 2017

J Natl Compr Canc Netw

922

897

View full text Add to dashboard Cite

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“…Recently, Van der Gaag et al reported results of a multi-center, randomized trial showing that endoscopic PBD did not have a beneficial effect on surgical outcomes for patients with pancreatic head cancer (18). Furthermore, it has been reported that among patients who underwent PBD, approximately 80% had a positive bile culture at the time of PD, resulting in infectious complications (19)(20)(21). They therefore did not recommend a routine PBD for patients who planned to undergo PD.…”

Section: Discussion Discussionmentioning

confidence: 99%

Optimal Duration of Prophylactic Antibiotics Administration in Pancreaticoduodenectomy

Yamamoto¹,

Satoi²,

Yanagimoto³

et al. 2017

SGO

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Purpose: Pancreaticoduodenectomy (PD) is considered a complex surgical procedure that is associated with a high morbidity. There has been no report on the optimal duration of prophylactic antibiotics administration to date. Mortality and morbidity, including surgical site infection (SSI) after PD, were compared retrospectively taking into account the period of prophylactic antibiotics administration. Methods: This study involved 158 patients who underwent PD between April 2006 and December 2010. Until March 2008 our hospital administered prophylactic antibiotics until post-operative day-2, but beginning in April 2008 they were administered only until postoperative day-1. Group A consisted of 71 consecutively treated patients who received cefmetazole (CMZ) as a prophylactic antibiotic intra-operatively and for 2 days postoperatively. Group B consisted of 87 consecutively treated patients who received CMZ intraoperatively and for 1 day post-operatively. During the study period, peri-operative management was standardized according to our departmental guidelines. Results: There were no significant differences in post-operative complications between the two groups. The most commonly isolated microorganisms from surgical drainage fluid were Enterobacter and Enterococcus species. Pre-operative biliary drainage was an independent risk factor for SSI (p<0.05). Conclusion: Limiting prophylactic antibiotics administration until post-operative day-1 did not increase morbidity after PD. However, we recommend long-term administration of prophylactic antibiotics for patients who undergo pre-operative biliary drainage.

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“…Although the results of the current randomized clinical study could not demonstrate any differences in bactobilia in perioperatively collected bile, it still offered arguments in favor of SEMS to optimize the preoperative course and the postoperative risk profile without the introduction of an enhanced risk for local complications. In previous studies it has been difficult to extract information about the true pros and cons of respective stent strategies, as only two studies, incorporating a limited number of patients, have compared plastic and metal stents for internal drainage [10,40]. However, a recent Dutch multicenter trial, with a case -control study design, demonstrated a clear superiority of SEMS [15].…”

Section: E804mentioning

confidence: 99%

Untitled

2017

Endosc Int Open

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A Matched Case-Control Study of Preoperative Biliary Drainage in Patients with Pancreatic Adenocarcinoma: Routine Drainage Is Not Justified

Abstract: In this case-matched control study, PBD was associated with a stent-related complication rate of 23% and resulted in a twofold increase in postpancreatectomy infectious complications. The routine use of PBD remains unjustified.

Cited by 109 publications

References 26 publications

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Optimal Duration of Prophylactic Antibiotics Administration in Pancreaticoduodenectomy

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