Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil.
Arq Bras Cir Dig. 2024 Sep 13;37:e1823. doi: 10.1590/0102-6720202400030e1823. eCollection 2024.
The unresectable pancreatic head tumors develop obstructive jaundice and cholestasis during follow-up. Cholestasis is associated with complications and treatment options are endoscopic stenting (ES) and biliary bypass surgery (BBS).
The aim of the current study was to compare the safety and efficacy of biliary bypass surgery (BBS) and endoscopic stenting (ES) for cholestasis in advanced pancreas cancer.
This is a retrospective cohort of patients with cholestasis and unresectable or metastatic pancreas cancer, treated with BBS or ES. Short and long-term outcomes were evaluated. We considered the need for hospital readmission due to biliary complications as treatment failure.
A total of 93 patients (BBS=43; ES=50) were included in the study. BBS was associated with a higher demand for postoperative intensive care (37 vs.10%; p=0.002, p<0.050), longer intensive care unit stay (1.44 standard deviation±2.47 vs. 0.66±2.24 days; p=0.004, p<0.050), and longer length of hospital stay (7.95±2.99 vs. 4.29±5.50 days; p<0.001, p<0.050). BBS had a higher risk for procedure-related complications (23 vs. 8%; p=0.049, p<0.050). There was no difference in overall survival between BBS and ES (p=0.089, p>0.050). ES was independently associated with a higher risk for treatment failure than BBS on multivariate analysis (hazard ratio 3.97; p=0.009, p<0.050).
BBS is associated with longer efficacy than ES for treating cholestasis in advanced pancreatic cancer. However, the BBS is associated with prolonged intensive care unit and hospital stays and higher demand for intensive care.
在随访过程中，不可切除的胰头肿瘤会发展为阻塞性黄疸和胆汁淤积。胆汁淤积与并发症有关，治疗选择包括内镜支架置入术（ES）和胆道旁路手术（BBS）。
本研究旨在比较胆道旁路手术（BBS）和内镜支架置入术（ES）治疗晚期胰腺癌胆汁淤积的安全性和疗效。
这是一项回顾性队列研究，纳入了接受 BBS 或 ES 治疗的伴有不可切除或转移性胰腺癌和胆汁淤积的患者。评估了短期和长期结局。我们将因胆道并发症而再次住院视为治疗失败。
共纳入 93 例患者（BBS=43 例；ES=50 例）。BBS 组术后需要入住重症监护病房的比例更高（37% vs. 10%；p=0.002，p<0.050），重症监护病房住院时间更长（1.44 标准差±2.47 天 vs. 0.66±2.24 天；p=0.004，p<0.050），住院时间也更长（7.95±2.99 天 vs. 4.29±5.50 天；p<0.001，p<0.050）。BBS 组与手术相关并发症的风险更高（23% vs. 8%；p=0.049，p<0.050）。BBS 和 ES 两组的总生存期无差异（p=0.089，p>0.050）。多变量分析显示，ES 与 BBS 相比，治疗失败的风险更高（风险比 3.97；p=0.009，p<0.050）。
BBS 治疗晚期胰腺癌胆汁淤积的疗效优于 ES，但 BBS 组的重症监护病房和住院时间延长，对重症监护的需求增加。
