Pancreatoduodenectomy Following Preoperative Biliary Drainage Using Endoscopic Ultrasound-Guided Choledochoduodenostomy Versus a Transpapillary Stent: A Multicenter Comparative Cohort Study of the ACHBT-FRENCH-SFED Intergroup.

Humans Choledochostomy / adverse effects Pancreaticoduodenectomy / adverse effects Cohort Studies Retrospective Studies Cholestasis / etiology Stents / adverse effects Endosonography Cholangiopancreatography, Endoscopic Retrograde / adverse effects Drainage / adverse effects Ultrasonography, Interventional

Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
Aug 2023
Historique:
received: 05 12 2022
accepted: 22 03 2023
medline: 7 7 2023
pubmed: 18 4 2023
entrez: 17 4 2023
Statut: ppublish

Résumé

It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD). Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed. Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups. PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.

Sections du résumé

BACKGROUND BACKGROUND
It is unclear whether preoperative biliary drainage (PBD) by endoscopic retrograde cholangiopancreatography (ERCP) is equivalent to electrocautery-enhanced lumen-apposing metal stent (ECE-LAMS) before pancreatoduodenectomy (PD).
METHODS METHODS
Patients who underwent PBD for distal malignant biliary obstruction (DMBO) followed by PD were retrospectively included in nine expert centers between 2015 and 2022. ERCP or endoscopic ultrasound-guided choledochoduodenostomy with ECE-LAMS were performed. In intent-to-treat analysis, patients drained with ECE-LAMS were considered the study group (first-LAMS group) and those drained with conventional transpapillary stent the control group (first-cannulation group). The rates of technical success, clinical success, drainage-related complications, surgical complications, and oncological outcomes were analyzed.
RESULTS RESULTS
Among 156 patients, 128 underwent ERCP and 28 ECE-LAMS in first intent. The technical and clinical success rates were 83.5% and 70.2% in the first-cannulation group versus 100% and 89.3% in the first-LAMS group (p = 0.02 and p = 0.05, respectively). The overall complication rate over the entire patient journey was 93.7% in first-cannulation group versus 92.0% in first-LAMS group (p = 0.04). The overall endoscopic complication rate was 30.5% in first-cannulation group versus 17.9% in first-LAMS group (p = 0.25). The overall complication rate after PD was higher in the first-cannulation group than in the first-LAMS group (92.2% versus 75.0%, p = 0.016). Overall survival and progression-free survival did not differ between the groups.
CONCLUSIONS CONCLUSIONS
PBD with ECE-LAMS is easier to deploy and more efficient than ERCP in patients with DMBO. It is associated with less surgical complications after pancreatoduodenectomy without compromising the oncological outcome.

Identifiants

DOI: 10.1245/s10434-023-13466-8 PMID: 37069476
pubmed: 37069476
doi: 10.1245/s10434-023-13466-8
pii: 10.1245/s10434-023-13466-8
doi:

Types de publication

Multicenter Study Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

5036-5046

Informations de copyright

© 2023. Society of Surgical Oncology.

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Auteurs

Julien Janet (J)

Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.

Jeremie Albouys (J)

Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France.
Faculté de Médecine de Limoges, Limoges, France.
CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France.

Bertrand Napoleon (B)

Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.

Jeremie Jacques (J)

Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France.
Faculté de Médecine de Limoges, Limoges, France.

Muriel Mathonnet (M)

Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.

Julien Magne (J)

CEBIMER, University of Limoges, Limoges, France.

Marie Fontaine (M)

Gastroenterology Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.

Charles de Ponthaud (C)

Department of HPB and Endocrine Surgery, Hôpital la pitié salpêtrière, APHP, Paris, France.

Sylvaine Durand Fontanier (S)

Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France.
CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France.

Sylvia S M Bardet (SSM)

CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France.

Raphael Bourdariat (R)

Digestive Surgery Department, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.

Laurent Sulpice (L)

Department of Digestive Surgery, CHU de Rennes, Rennes, France.
Faculté de Médecine de Rennes, Rennes, France.

Mickael Lesurtel (M)

Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France.

Romain Legros (R)

Hepato-Gastroenterology Department, CHU Dupuytren, Limoges, France.
Faculté de Médecine de Limoges, Limoges, France.
CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France.

Stephanie Truant (S)

Depatment of Digestive Surgery and Transplantation, Hôpital Huriez - CHRU de Lille, Lille, France.

Fabien Robin (F)

Department of Digestive Surgery, CHU de Rennes, Rennes, France.
Faculté de Médecine de Rennes, Rennes, France.

Frédéric Prat (F)

Department of Endoscopy, Beaujon Hospital, APHP, Clichy, France.

Maxime Palazzo (M)

Endoscopy Unit, Hôpital Européen, Marseille, France.

Lilian Schwarz (L)

Digestive Surgery Department, CHU de Rouen, Rouen, France.

Emmanuel Buc (E)

Digestive Surgery Department, CHU de Clermont, Ferrand, France.

Alain Sauvanet (A)

Department of HPB Surgery, Beaujon Hospital, APHP, Clichy, France.

Sebastien Gaujoux (S)

Department of HPB and Endocrine Surgery, Hôpital la pitié salpêtrière, APHP, Paris, France.

Abdelkader Taibi (A)

Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France. abdelkader.taibi@chu-limoges.fr.
CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France. abdelkader.taibi@chu-limoges.fr.
ORCID: 0000-0002-1036-6474

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Procédures de chirurgie des voies biliaires › Cholédocostomie › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie digestive › Duodénopancréatectomie › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladie des voies biliaires › Maladies des canaux biliaires › Cholestase › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Équipement et fournitures › Prothèses et implants › Endoprothèses › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Échographie › Endosonographie › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Cholangiopancréatographie rétrograde endoscopique › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Drainage › Pancreatoduodenectomy Following Preoperative...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Échographie interventionnelle › Pancreatoduodenectomy Following Preoperative...