Survival Analysis Among Unresectable Pancreatic Adenocarcinoma Patients Undergoing Endoscopic or Percutaneous Interventions

Overview

Journal Gastrointest Endosc

Specialties Gastroenterology
Pharmacology
Radiology

Date 2020 Jun 13

PMID 32531402

Citations 4

Authors

Anna Tavakkoli

B Joseph Elmunzer

Akbar K Waljee

Caitlin C Murphy

Sandi L Pruitt

Hong Zhu

Rong Rong

Richard S Kwon

James M Scheiman

Joel H Rubenstein

Amit G Singal

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Most patients with pancreatic cancer are diagnosed at a late stage and are not candidates for surgical resection. Many have jaundice requiring biliary drainage, which can be accomplished using ERCP or percutaneous transhepatic biliary drainage (PTBD). To date, no studies have evaluated the impact of ERCP or PTBD on survival among patients with unresectable pancreatic cancer. The aims of our study were to compare overall survival between patients with unresectable pancreatic cancer receiving ERCP with those receiving PTBD, to compare overall survival between patients who received a biliary intervention (ERCP or PTBD) versus those who received no biliary intervention, and to compare secondary outcomes, such as length of hospital stay and costs, between ERCP and PTBD.

Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results-Medicare database. Patients with known pancreatic cancer were included if they had a pancreatic head mass and/or evidence of biliary obstruction. We used a time-varying Cox proportional hazards model to estimate overall survival of patients receiving ERCP versus PTBD and overall survival among patients who received a biliary intervention versus no biliary drainage. Secondary outcomes included length of hospital stay, costs, and admissions within 30 days.

Results: Of 14,808 patients with unresectable pancreatic cancer, 8898 patients (60.0%) underwent biliary drainage and 5910 patients (39.9%) received no biliary intervention. ERCP accounted for most biliary interventions (8271, 93.0%), whereas 623 patients (7.0%) underwent PTBD. In multivariable analysis, ERCP was associated with reduced mortality compared with PTBD (adjusted hazard ratio [aHR], .67; 95% confidence interval [CI], .60-.75). When ERCP or PTBD was compared with no biliary intervention, both procedures were associated with a survival benefit (aHR, .51 [95% CI, .49-.54] and .53 [95% CI, .48-.59], respectively). Compared with patients receiving PTBD, those who underwent ERCP had shorter mean length of hospital stay (7.0 ± 5.7 days vs 9.6 ± 6.6 days, respectively; P < .001) and lower hospital charges ($54,899.25 vs $75,246.00, P < .001) but no significant difference in hospitalization or 30-day readmissions.

Conclusions: ERCP is associated with reduced mortality compared with PTBD in pancreatic cancer patients, highlighting the critical role of ERCP in the management of biliary obstruction from pancreatic cancer.

Citing Articles

Advances in Endoscopic Ultrasound in Pancreatic Cancer Screening, Diagnosis, and Palliative Care.

Zhang W, Chen J, Zhang W, Xu M Biomedicines. 2025; 13(1).

PMID: 39857661 PMC: 11762820. DOI: 10.3390/biomedicines13010076.

Changes over time in treatment for obstructive jaundice.

Aoki H World J Gastrointest Surg. 2024; 16(10):3074-3077.

PMID: 39575272 PMC: 11577415. DOI: 10.4240/wjgs.v16.i10.3074.

Surgical Palliation for Advanced Pancreas Cancer.

Jacobs C, Vitello D, Chawla A Surg Clin North Am. 2024; 104(5):1121-1135.

PMID: 39237168 PMC: 11377866. DOI: 10.1016/j.suc.2024.04.008.

Accessibility to ERCP-performing hospitals among patients with pancreatic cancer living in SEER regions.

Tavakkoli A, Beauchamp A, Prasad T, Zhu H, Singal A, Elmunzer B Cancer Med. 2024; 13(3):e7020.

PMID: 38400670 PMC: 10891451. DOI: 10.1002/cam4.7020.

Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review.

Mazur R, Trna J Biomedicines. 2023; 11(10).

PMID: 37893064 PMC: 10603964. DOI: 10.3390/biomedicines11102690.

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