Massachusetts General Hospital, Department of Medicine, United States.
Memorial Sloan Kettering, Department of Medicine, Division of Hematology Oncology, United States.
Am J Surg. 2021 Jan;221(1):134-140. doi: 10.1016/j.amjsurg.2020.07.025. Epub 2020 Aug 11.
Preoperative biliary stenting is required for patients with obstructive jaundice from pancreatic adenocarcinoma who are receiving neoadjuvant chemotherapy. While in most patients this approach results in durable biliary drainage, some patients develop cholangitis during neoadjuvant treatment. Further, several studies have shown that preoperative cholangitis in patients with hepatobiliary malignancies can result in substantially unfavorable outcomes. The aim of this study was to evaluate the impact of preoperative cholangitis in patients who underwent pancreaticoduodenectomy after completing neoadjuvant chemotherapy.
Participants: all adult patients (n = 449) diagnosed with pancreatic adenocarcinoma from January 1st, 2013 to March 31st, 2018 who pursued treatment at the Massachusetts General Hospital were screened. Of these 449 patients, 97 met final inclusion criteria of receiving neoadjuvant chemotherapy with intent to pursue curative surgery. Data were collected via retrospective chart review including baseline characteristics, survival, episodes of preoperative cholangitis, and surgical complications.
In patients completing successful pancreaticoduodenectomy surgery, preoperative cholangitis is associated with increased mortality (HR 2.67, 95% CI:1.16-6.13). This finding is independent of postoperative outcomes or tumor recurrence rate. The presence of cholangitis did not impact completion of neoadjuvant chemotherapy (92% vs 85%, p = 0.5) or ability to proceed to surgery (76% vs 75%, p = 1.0). Preoperative cholangitis was not associated with postoperative morbidity (42.1% vs 45.1%, p = 1.0).
One episode of cholangitis during neoadjuvant chemotherapy is associated with increased mortality following successful pancreaticoduodenectomy, independent of immediate postoperative outcomes or tumor recurrence. Preoperative cholangitis does not affect ability to pursue neoadjuvant chemotherapy or complete successful surgery. Patients who develop cholangitis during the neoadjuvant chemotherapy treatment phase may reflect a distinct phenotype of patients with PDAC with a complex and more challenging clinical course.
接受新辅助化疗的胰头腺癌所致梗阻性黄疸患者需要术前胆道支架置入。虽然在大多数患者中，这种方法可实现持久的胆道引流，但有些患者在新辅助治疗期间会发生胆管炎。此外，多项研究表明，肝胆恶性肿瘤患者术前胆管炎可导致预后显著不良。本研究旨在评估新辅助化疗后行胰十二指肠切除术的患者术前胆管炎的影响。
参与者：2013 年 1 月 1 日至 2018 年 3 月 31 日在马萨诸塞州总医院接受治疗的所有被诊断为胰头腺癌的成年患者（n=449）均接受了筛查。在这 449 名患者中，有 97 名符合最终纳入标准，即接受新辅助化疗并计划进行根治性手术。通过回顾性病历回顾收集数据，包括基线特征、生存情况、术前胆管炎发作和手术并发症。
在成功完成胰十二指肠切除术的患者中，术前胆管炎与死亡率升高相关（HR 2.67，95%CI：1.16-6.13）。这一发现独立于术后结果或肿瘤复发率。胆管炎的存在并不影响新辅助化疗的完成（92%对 85%，p=0.5）或手术的进行（76%对 75%，p=1.0）。术前胆管炎与术后发病率无关（42.1%对 45.1%，p=1.0）。
新辅助化疗期间发生一次胆管炎与胰十二指肠切除术后的死亡率升高相关，这与术后即刻结果或肿瘤复发无关。术前胆管炎不影响进行新辅助化疗或完成成功手术的能力。在新辅助化疗治疗阶段发生胆管炎的患者可能反映出 PDAC 患者的一种独特表型，具有复杂且更具挑战性的临床过程。
