Postoperative pancreatitis after pancreaticoduodenectomy predicts clinically relevant postoperative pancreatic fistulas

Abstract

s / Pancreatology 15 (2015) S1eS141 S101 pancreatic adenocarcinoma. There is scarce information on predictors of survival after ERCP. Aims: Evaluate survival predictors after ERCP biliary drainage in pancreatic adenocarcinoma. Patients & methods: Cross-sectional study of patients referred for ERCP biliary drainage of obstruction conditioned by advanced pancreatic adenocarcinoma, over a period of 3 years. Results: Seventy-nine patients underwent biliary drainage. Mortality rate at 3 months was 39% and at 6 months was 62%. Mortality was higher in patients with higher AST (178U/L vs 73U/L, p1⁄40.031), higher ALT (221U/L vs 85U/L, p<0.001), higher GGT (970U/L vs 423U/L, p1⁄40.014) and higher AF (816U/L vs 469U/L, p1⁄40.033). Survival was lower in patients who began adjuvant therapy prior to ERCP (80 days vs 302 days, p1⁄40.006), in patients withmetastasis (63 days vs 160 days, p1⁄40.013) and tend shorter in patients who placed longer stents (80 days vs 157 days, p1⁄40.073). In multivariate analysis, survival was lower in patients who began adjuvant therapy prior to ERCP (HR 3.8, p1⁄40.012), with higher AST (HR 1.1, p1⁄40.003), with higher bilirubin (HR 1.2, p1⁄40.004) and with lower decrease of bilirubin after drainage (HR 1.4, p<0.001). Conclusion: Biliary stents by ERCP allows lasting palliation of symptoms in pancreatic adenocarcinoma, even in situations where it is not possible to perform chemotherapy. Best results are obtained in patients who started adjunctive therapy after ERCP, in those with lower AST and bilirubin and in those with higher decrease of bilirubin after ERCP.